AAPA Special Interest Group Application

Thank you for your interest in forming an AAPA recognized Special Interest Group. We are here to assist you and look forward to the great work that your group will do for the profession. Upon submission, the application will be added to the meeting agenda of the Constituent Relations Work Group (CRWG) for review and recommendation to AAPA board of directors. If approved, you will receive an affiliation agreement. Specific obligations outlined in the affiliation agreement are required to maintain official recognition status.

AAPA POLICY

The AAPA is governed by its Bylaws & Policies. Policy requirements specific to Special Interest Groups are found under BA-2300.7.0 beginning on page 43. Please review the policy requirements prior to submitting the application.

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NOTE: The information requested in Section C of the form is not a requirement for Special Interest Groups. Please complete only if applicable.

For additional information, email coadministrator@aapa.org or call 571-319-4436.

A. ORGANIZATION INFORMATION:

Name of Special Interest Group (Please do not use acronym.) *

Mailing address for Special Interest Group: *

City: *

State: *

Zip Code: *

Special Interest Group phone number: *

Email address for Special Interest Group business: *

Special Interest Group web address (if applicable):

Date Special Interest Group founded (MM/YYYY):

Please enter the total number of group supporters/members:

Special Interest Groups are required to have a minimum of 5 AAPA fellow members as founding supporters. Please provide the founding member names here: *

B. GOALS AND PURPOSES

List the mission and purposes of the Special Interest Group:

Is there an existing CO with a similar mission or that serves a similar population? *

Yes

No

If yes, have you reached out to them to inquire about joining them?

Please provide a detailed description of how the proposed CO is different from any of the current AAPA approved Constituent Organizations. *

List specific activities the Special Interest Group has planned for the future:

C. GOVERNING INFORMATION

Does the Special Interest Group have elected Officers?

Yes

No

If yes, please select leadership term: *

If Special Interest Group has Officers, please list names and contact information:

President

Email

President-Elect

Email

Vice-President

Email

Secretary

Email

Treasurer

Email

Secretary/Treasurer

Email

Have bylaws been developed for this group?

Yes

No

If yes, please upload Bylaws:

Is Special Interest Group incorporated? (Not an AAPA policy requirement)

Yes - Process Complete

In Process

No

If incorporated, please provide name of state where incorporated:

If incorporated, are filings (formal reports) due to the state of incorporation?

If incorporated, please upload Articles of Incorporation:

Fiscal year begins in what month?

Has application been made to the IRS for a tax exemption certificate? (Not required, but recommended.)

Yes

In Process

No

If tax exemption certificate has been granted by IRS, under which section of the Code is exemption granted?

501(c)3

501(c)6

501(c)10

Other

If tax exemption granted, upload Letter of Determination from IRS:

Does Special Interest Group have a tax identification number? If so, please provide. (Not required, but recommended.)

Yes

In Process

No

Tax Identification Number/Employee Identification Number (TIN/EIN):

D. CONTACT INFORMATION

Name of person submitting form *

Position in organization

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

With this application I affirm that the proposed Special Interest Group of AAPA will operate in a manner that is consistent with AAPA vision, mission, bylaws and policies.

Thank you for your application. The Constituent Relations Work Group meets quarterly and will be in contact. In the interim, if you have any questions about the application or review process, please contact coadministrator@aapa.org or call 571-319-4436.

Date of application submission (MM/DD/YYYY):