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General Fellow Application
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Military Record

State Medical or Dental Licensure

Please upload a copy of the following documents
Have any of the following ever been or are in the process of being denied, revoked, suspended, reduced, not renewed or voluntarily relinquished (by either resignation or expiration)?

Please answer the following questions:

Please list the name and address of the three letters of reference you will be submitting or upload references.

By submitting this form you certify that the information contained in this application is complete and you are capable and qualified for the training program. Any misstatement in or omission from this application constitutes cause for dismissal from the program. You also understand that the American Academy of Cosmetic Surgery (AACS) only facilitates the collection of Fellowship applications and is in no way part of the Fellow-in-Training selection process.

You authorize AACS and the Fellowship Directors to consult and seek information regarding your present and past liability and qualifications. AACS and Fellowship Directors reserve the right to review any submitted documentation.

You hereby release from liability AACS and the Fellowship Directors for their acts performed in good faith without malice in connection with evaluating you and your credentials or in providing information concerning your application for the training program.