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Qualifications for Fellowship

Dear Applicant:

Fellowship in AGPA is an honor. It demonstrates outstanding professional competence and leadership capacities. Fellowship enhances the reputation of both the Fellow and the Association, as Fellows represent, in a visible way, the highest quality of the Association. The Fellowship Committee takes five areas of activity into consideration and expects that candidates have shown excellence and leadership in at least two, one of which must be leadership in AGPA, the Affiliate Societies and other Group Psychotherapy related organizations.

The Fellowship and Awards Committee reviews the applicant's professional experiences and then decides whom to recommend to AGPA's Board of Directors. The Board makes the final decision by vote.

When filling out applications, candidates must consider the stated criteria in the "Professional Activities Considered for Fellowship." Candidates must list relevant experiences in General Leadership and in at least one other category. It is important to provide specific details, including: dates, titles, location and responsibilities. For presentations, length, title and sponsoring organization are important. If presentations are used to fulfill leadership requirements, they should be listed under "leadership;" the same presentations cannot be used again to fulfill requirements for teaching and training or other areas.

Local and Regional Societies: The Fellowship Committee takes into consideration the recommendations of the Regional and Local Societies.

Ethical Standing: Candidates are expected to conform to standards of ethical practice in their professional organizations and within AGPA.

Invitation of a Fellowship Application: Any AGPA member who has been a CERTIFIED GROUP PSYCHOTHERAPIST or PROFESSIONAL member for a minimum of 5 years can submit an application if it is sponsored by two Fellows. The Affiliates Societies or National Association Fellowship and Awards Committee may also propose candidates. The AGPA Fellowship and Awards Committee always welcomes suggestions for suitable candidates.

We look forward to receiving your application.

Sincerely,

Fellowship and Awards Committee

Application for Fellowship

Please fill in the fields below. When completed hit submit.

Name * Please enter your name

Degree

CGP

Yes

Street Address

Address (cont.)

City

State

Zip

Work Phone

Home Phone

Fax

E-mail *

Please enter your email address

Invalid email format

Date of AGPA Professional Membership: -- mm/dd/yy

If applicable, date of last application for Fellowship: -- mm/dd/yy

Fellowship Requirements

APPLICATION

Members of the Association in good standing:
1) Who have been CGP or Professional members for five years, unless this requirement is waived by unanimous vote of the Board of Directors;
2) Whose outstanding performance in the field of group psychotherapy has been demonstrated by Leadership in Organizational Service;
3) Who also demonstrates excellence in one of the following areas:

II-A) Clinical Practice and Administration;
II-B) Teaching;
II-C) Research; and/or
II-D) Publications

Please provide information requested. Lines will appear as needed providing additional space.

I. General Leadership (if additional space is needed, please attach a separate sheet):

1. Officer (AGPA/GF/IBCGP, Affiliate/Regional, International Group Organization, Other)

Organization	Positions Held	Dates

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2. Board (Specify the Board, Committee and/or your role(s) including dates for each)

Organization	Positions Held	Dates

			Delete
			Delete

3. Chair (AGPA/GF/IBCGP, Affiliate/Regional, International Group Organization, Editor of a Peer Review Group Journal, Other)

Organization	Positions Held	Dates

			Delete
			Delete

4. Committee/Task Force Member (AGPA/GF/IBCGP, Affiliate/Regional, International Group Organization, Editor of a Peer Review Group Journal)

Organization	Positions Held	Dates

			Delete
			Delete

5. AGPA Representative to other professional organization

Organization	Positions Held	Dates

			Delete
			Delete

6. Faculty at Scientific/Training meeting (AGPA, Affiliate/Regional, Other related group organizations)

Organization/Conference	Hours/All day workshops	Workshops/Seminars	Paper Presentations	Dates

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					Delete
					Delete

7. Group Therapy Related Awards and Honors (AGPA, Other)

Organization	Honor or Award	Dates

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II. Please identify ONE additional category cited below for which you have demonstrated excellence and list these specific activities with associated dates using the following format.

* Activities reported in category I (General Leadership) may not be duplicated in category II-B (Teaching and Training)--choose one.

Does 50% or more of your work reported in this section reflect work with individuals from underrepresented groups, historically marginalized communities, or individuals with marginalized identities. In particular, are these groups comprised of folks who hold differential power from those who hold the majority power in the population (e.g., ethnic, racial, religious, or other group)? If yes, please explain briefly what you include in providing that answer.

II - A) Clinical Practice and Administration

1. Active Group Psychotherapy Practice (includes pro-bono services)

Group(s)	Years running

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		Delete

2. Group Therapy Programs (development, administration, director, supervisor, leader of supervision/training, leader of therapy groups)

Group(s)	Years running

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		Delete

II - B) Teaching and Training

1. Group Therapy Supervision/Consultation

Setting	Frequency	Dates

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			Delete

2. Group Therapy Teaching

Setting	Frequency	Dates

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			Delete

3. Part Time Lecturer/Presenter on Group Therapy

Setting	Frequency	Dates

			Delete
			Delete

4. Leader of a training group

Setting	Frequency	Dates

			Delete
			Delete

5. Faculty at AGPA, Affiliates, other Group-Related organizations, and other scientific and/or training meetings where group related material is presented

Setting	Title (Institute/ Workshop / Seminar/ Length)	Dates

			Delete
			Delete

6. Training on Media Platform (podcasts, online trainings, etc.)

Title	Length	Dates

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			Delete

II-C) Research

1. Director of Research Project re: Groups

Title	Setting	Dates	Part time/Full time

				Delete
				Delete

2. Developer of Group Research Methodology

Title	Setting	Dates	Part time/Full time

				Delete
				Delete

3. Researcher of Group related issues

Title	Setting	Dates	Part time/Full time

				Delete
				Delete

4. Promoter of Research on Groups (Teaching, grant writing, theses or dissertation committees)

Title	Setting	Dates	Part time/Full time

				Delete
				Delete

II-D) Publications

1. Publication on Groups in peer Reviewed Journals, Chapters, and books

List publications on groups

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2. Editor of IJGP

Dates

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3. Editor of Group Circle

Dates

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	Delete

4. Editorial Staff of a Group Newsletter (Group Circle, Group Solutions, Group Assets, or other newsletter)

Setting	Dates

		Delete
		Delete

5. Editorial Board (IJGP or other group journal)

Setting	Dates

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		Delete

6. Other related but non-group focus

Setting	Dates

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7. Book Reviews (group related)

Setting	Dates

		Delete
		Delete

8. Podcast/Broadcast on Media Platform

Date	Length

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		Delete

Please identify any additional experience which you would like the Fellowship and Awards Committee to consider.

III. PERSONAL STATEMENT

Please share your personal and professional journey in developing cultural humility. Please include your approach to incorporating antiracism and anti-oppression values in your work (clinical practices, group psychotherapy, research, training, supervision, scholarship, etc.). 200 word limit.

IV. Names and addresses of two fellows of AGPA who have agreed to endorse your application (please append letters of reference to the application).

1.Name

Street Address

Address (cont.)

City

State

Zip

2.Name

Street Address

Address (cont.)

City

State

Zip

V. Please send a copy of your curriculum vitae with this application. Information on the curriculum vitae will not be accepted as a substitute for completing the above information; it is an addendum to the application.

C.V. Please upload PDF or Word file

Date: -- mm/dd/yy

Signature