Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.

American Head & Neck Society | AHNS

The mission of the AHNS is to advance Education, Research, and Quality of Care for the head and neck oncology patient.

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Letter of Recommendation for Active or Corresponding Membership

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Please report any problems with this form to webmaster@ahns.info
Sponsor Name*
First Last
Sponsor Email*
Are you a member of AHNS?*
- Yes
- No
Fellow Name*
Fellow Class*
Which class is the fellow upgrading to?
- Active (within USA or Canada)
- Corresponding (outside of USA or Canada)
In reference to this fellow's upgrade from Candidate to Active or Corresponding AHNS membership, would you be willing to comment on his/her professional competence and character?*
- Yes
- No
If not, why not?*

How long have you known this fellow professionally?*
Did you work with the fellow during his/her fellowship?*
- Yes
- No
In what capacity?*
- Fellowship Director
- Faculty
- Research Mentor
Is the fellow's practice within the scope of the AHNS?*
(e.g. actively engaged in diagnosis, treatment, and rehabilitation of patients with neoplasms and other diseases of the head and neck and the prevention of neoplasms and other diseases of the head and neck)
- Yes
- No
Have you assisted the fellow, or has the fellow assisted you, at surgery?*
- Yes
- No
Do you know of any adverse (reportable) action taken in the past or present or is pending which could limit or restrict the fellow's medical license or hospital staff privileges (including required supervision or monitoring) at any hospital?*
If yes, please provide additional information in the comment box at the bottom of the application and/or attach appropriate documentation.
- Yes
- No
What is your opinion as to the fellow's...*
Excellent Good Average Fair Poor
Surgical and clinical judgement?
Professional and ethical conduct
Do you support this person's upgrade to Active or Corresponding AHNS membership?*
- Yes, without reservation
- Yes, with reservation (add comment in below comment box)
- No (add comment in below comment box)
Please add any comments or concerns regarding the applicant here.
This information will only be seen by the AHNS office and Membership & Credentials Service
Please upload any additional files/documentation if needed.
Drop files here or