ACG 2025-2026 Emerging Leadership Program Application - American College of Gastroenterology

Applicant Name

Name of Applicant*

First Middle Last Credentials

Eligibility Requirements

Are you an ACG Member in good standing?*

Current membership in good standing at the time of application is required. If you are NOT an ACG member in good standing, please contact ACG’s membership services department for information on becoming a member: 301-263-9000 or visit: gi.org/join-acg.

Yes
No

Year of Fellowship*

Please indicate your current year of fellowship. Participants must be in their 3rd or 4th year of GI fellowship.

3rd year
4th year

Year Completing GI Fellowship*

Please indicate the year in which you will be completing fellowship . Participants must be in their 3rd or 4th year of GI fellowship.

2024
2025

Supervisor evaluation acknowledgement*

ACG will ask you to provide the name and contact information of your supervisor for survey purposes (both pre and post-course). This individual will be asked by ACG to gauge your growth as a leader over time. Information provided is fully confidential.

I acknowledge and understand that ACG will contact my supervisor who will evaluate my growth as a leader. Supplying the name and contact information for my supervisor is an expectation of participants and for successful completion of the program.

Name of Supervisor*

First Middle Last Credentials

Supervisor's email*

How did you learn about the Emerging Leaders Program*

Please indicate how you learned about ELP. This information is helpful in determining how best to recruit participants and grow the program.

Email
Social Media Posting
ACG Website
ACG Flyer or Publication
The Person Who Nominated Me
Word of Mouth

Applicant Information

Title/Position*

Gender*

Female
Male
Other
Prefer not to answer

How would you describe your race?*

How would you describe your ethnicity?*

Email (Preferred)*

Twitter Handle / Social Media Identifiers (enter N/A if unavailable)*

Mobile Phone*

Professional Information

Name of Institution*

Work Location*

City State ZIP Code

Preferred Area of Specialty #1*

Preferred Area of Specialty #2*

Applicant Background and Experience Statements

1. What past leadership experiences have you had? Please include activities both within and outside of ACG (for example: committee work, NACGF, abstract review, leadership roles within your institution, etc.)?*

200 words minimum

2. What is an example of a past leadership challenge you faced and how did you address it?*

200 words minimum

3. What is an example of a successful leadership accomplishment?*

200 words minimum

4. What is a leadership challenge that you are currently facing?*

200 words minimum

5. Describe your leadership goals.*

200 words minimum

Nominator

Name of your nominator*

Name of individual nominating you for the ELP– GI Program Director, Chief of GI, Division Director, or equivalent position / ACG Governor / Fellow of ACG – FACG, MACG.

First Last Credentials

Is the nominator an ACG Member?*

Yes
No

What is the nominator's title?*

What is the name of the nominator's Institution or practice?*

Nominator's email address:*

Required Uploads

Upload a copy of your CV:*

Must be in PDF or DOC format.

Accepted file types: pdf, doc, docx, Max. file size: 50 MB.

Upload a letter of nomination*

Please note the NEW format for the letter of nomination – use the form found at the top of this page or on the ELP web page. The format has changed from the standard narrative to 3 focused questions to be completed by the nominator. The nominator should be someone (an active ACG member preferred) who has direct knowledge of the applicant’s qualifications and leadership potential and who meets one or more of the following criteria — 1) GI Program Director, Chief of GI, Division Director, or equivalent position 2) ACG Governor 3) Is a fellow of ACG – FACG, MACG.

Accepted file types: pdf, doc, docx, Max. file size: 50 MB.

Upload a headshot (photo)*

For successful applicants, this will be shared with your Emerging Leaders cohort, along with your contact information, prior to meeting in December.

Accepted file types: jpg, jpeg, tif, , Max. file size: 50 MB.

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