2019 Application for Fellow ASHE

This is the official application for Fellow status with ASHE. All candidates must complete this form in its entirety, and include a signature and date.

Before beginning this application make sure you have 30-45 minutes of uninterrupted time to fully complete this process. You will not have the opportunity to save your answers and return later to complete the application.

Please follow the directions as indicated and answer all applicable questions. After you have completed the application, you will be instructed to upload your supporting documentation and professional photo.

You can download a copy of the Criteria for Fellow at www.ashe.org

If you have questions, contact Charmaine Osborne at cosborne@aha.org.



The application for Fellow status is divided into six (6) parts:

Part 1 - Contact information
Part 2 - Professional background
Part 3 - Contribution to the Field
Part 4 - Signature & Date
Part 5 - Supporting documentation
Part 6 - Submitting your application



Please complete the information below and be sure to provide a valid e-mail and phone where you can be reached.



















As a candidate for Fellow you must submit documentation to demonstrate you meet the requirements in this area.

All supporting documentation must correspond to the answers, statements, and/or examples you provide on this application.



Individuals must obtain an official letter from ASHE to confirm you have ten (10) years or more of consecutive membership (with no break in service) at the time of application.

You must have a recorded join date prior to January 1 2010 to meet the requirement for Fellow.

A copy of the official letter must be included as part of your supporting documentation.





Individuals must hold the designation of Senior for three (3) years at the time of application. You must have achieved your Senior designation in the year of 2015 or prior.


Your supporting documentation must include documentation verifying your Senior status.

Please indicate the year you earned the Senior designation.



Individuals must document two (2) examples of academic/professional accomplishments.

Your portfolio must include supporting documentation verifying each example indicated on this application.



Use the drop down menu to make your selection


Use the drop down menu to make your selection


Individuals must document a minimum of 50 contact hours of ASHE/AHA approved continuing education credit earned within 10 (ten) years at the time of application.

Education must have been completed after January 1, 2009.



Your portfolio must include supporting documentation verifying the total number of continuing education hours indicated on this application.

Please indicate the total number of continuing education hours.



Individuals must be actively employed at the time of application and have ten (10) years or more of work experience in a position with primary responsibility related to the profession of healthcare engineering, facility management, or as a healthcare architect or engineering consultant.


Supporting documentation must include a recent copy of your resume to demonstrate years of experience.

Please indicate years of industry experience.




Candidates for Fellow must demonstrate their contribution to the field by providing examples of achievements/experience in each of the following categories:

1) Leadership
2) Lecturing
3) Publishing

NOTE: Documentation previously submitted for Senior cannot be re-submitted to apply for Fellow.

The applicant will be required to submit supporting documentation that corresponds to the answers and/or examples provided on this application.



Document two (2) different leadership positions held within ten (10) years prior to application.

Examples of Leadership experience must be completed after January 1, 2009.



Indicate position held, organization, and year. Documentation must support answer/example given in the space provided below.

EXAMPLE:
Regional Director, ASHE, 2014



Indicate position held, organization, and year. Documentation must support answer/example given in the space provided below.

EXAMPLE:
Chapter President, HESNI, 2012



Document two (2) different examples of lecturing within ten (10) years prior to application.

Examples of Lecturing experience must be completed after January 1, 2009.


EXAMPLE:
#1 - Speaker, Infection Control in the OR, ASHE Annual Conference, July 2010
#2 - Co-presenter, Performance Management Preparing your FM team for Success, IFMA Conference 2012



Indicate the title, date, name of program/event, and your role in the presentation. Documentation must support your answer/example given in the space provided below.

EXAMPLE:
Infection Control in the OR, ASHE Annual Conference, July 2010, Speaker



Indicate the title, date, name of program/event, and your role in the presentation. Documentation must support the answer/example given in the space provided below.

EXAMPLE:
Performance Management Preparing your FM Team for Success, IMFA Conference, February 2012, Co-presenter



Document articles, white papers, or other publishing examples published within ten (10) years at the time of application.

Examples of Publishing must be completed after January 1, 2009.



Indicate your examples of Publishing from the drop down menu below.


Indicate title, name of publication and date. Documentation must support the answer/example given in the space provided below.

EXAMPLE:
Breaking Barriers Claiming Your Seat at the Table, Inside ASHE, July-August 2010



Indicate title, name of publication, and date. Documentation must support answer/example given in the space provided below

EXAMPLE
Documenting the PDC Process, approved for future publication by ASHE, September 2017




Sign and date your application by indicating a check mark in the Signature box below.



Please enter your full name as you would like it to appear in print.(include prefix, suffix, and designations)




Feel free to include any comments, or other relevant information specific to your application.



Candidates for Fellow will be required to provide supporting documentation that will be reviewed by a select taskforce, in order to determine your eligibility for the Fellow designation. The supporting documentation validates the answers, statements, and examples you provided on this application.

To ensure a thorough review of your application, be sure your supporting documentation is compiled and organized for easy reference and verification, as indicated below:

Cover Page
-Full name
-Company
-Phone
-Email

Professional Background
-ASHE membership
-Senior designation
-Academic/Professional
-Continuing education
-Professional Experience/Resume

Contribution to the Field (all categories are required for Fellow)
-Leadership
-Lecturing
-Publishing



Carefully read and follow the instructions below. You will be required to upload two (2) separate files

File 1 - Supporting Documentation
Make sure all of your supporting documentation is compiled as noted above and scanned as one (1) PDF file.


File 2 - Professional Photo (headshot)
Your professional photo should be a color, high-resolution, headshot/photo saved electronically in JPEG file format

Maximum file limit for both files (total) should not exceed 30MB.

NOTE:
- Word documents cannot be accepted.
- Multiple files/PDFs cannot be accepted
- Multiple files/PDFs sent via to ASHE via email cannot be accepted.



To upload your documents hit UPLOAD search/enter the document name from your computer hard drive or zip file. Hit OK/Enter.

Repeat instructions to upload the second file.

Maximum file limit (total of both files) should not exceed 30MB.




You are responsible for the accuracy and completeness of your application and portfolio. Before you submit your application, go back and make sure you have completed the application in its entirety. Review your answers. Make sure your answers have the appropriate supporting documentation, Make sure your application is signed and dated and that you have uploaded the required information.

To receive a copy of this application via e-mail, check the box marked "Send me a copy of my responses" at the bottom of this application form.

Your application is not official until you hit "SUBMIT". Once you hit submit you will get a notification of receipt via e-mail.

If there are any changes/additions to your application after you hit the submit button, contact Charmaine Osborne at cosborne@aha.org for further instructions.

If you have questions contact Charmaine Osborne at cosborne@aha.org.


Thank you.







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