Fellowship Application Form

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Section 1 - Applicant Details

*Full Name

*Job Title

*Organisation

Professional Registration (if applicable)

*Email Address

*Contact Number

*ARTP Membership Number

*Year of First ARTP Membership

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Section 2 - Eligibility Confirmation

Please confirm the followingI have been a full member of ARTP for at least 10 yearsI confirm that I meet at least 3 of the 5 Fellowship domainsI agree to abide by ARTP professional standards and code of conduct

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Section 3 - Professional Summary

*Provide a concise overview of your career and your contribution to respiratory and/or sleep science. This should highlight your key achievements, leadership roles, and areas of impact

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Section 4: Domain-Based Evidence

*You must complete all sections, but should demonstrate strength in at least three domains. Focus on impact, not just activity and clearly describe your personal contribution. Include scale (local/regional/national/international). Provide examples and outcomes.

Section 4.1

Service to the Professional Body

*Describe your contribution to ARTP and/or the wider professional body (Max 400 words)

*Evidence of Impact

Section 4.2

Education and Training

*Describe your contribution to education, training, and workforce development (Max 400 words)

*Evidence of Impact

Section 4.3

Innovation (Research/Scholarship)

*Describe your contribution to research, innovation, or scholarly activity (Max 400 words)

*Evidence of Impact

Section 4.4

Workforce (Leadership & Service Development)

*Describe your leadership and contribution to workforce or service delivery (Max 400 words)

*Evidence of Impact

Section 4.5

Quality (Standards & Improvement)

*Describe your contribution to quality, standards, or professional practice (Max 400 words)

*Evidence of Impact

Section 5: Mapping to Fellowship Criteria

Please indicate which domains you believe represent your strongest contributions (select at least three)Service to Professional BodyEducation and TrainingInnovationWorkforceQuality

Section 6: Supporting Evidence

Please provide supporting evidence (where available)

*Key publications (max 5):

*National/international presentations (max 5)

*Leadership roles (current/recent)

*Awards or recognitions

Section 7

Referee Statements

Please provide details of two referees who can support your application. Referees should be familiar with your work and ideally be senior professionals or leaders in the field.

*Referee 1 Name

*Referee 1 Role/Title

*Referee 1 Organisation

*Referee 1 Professional Registration No.

*Referee 1 ARTP Membership No.

*Relationship to applicant

*Referee 1 Email Address

*Referee 2 Name

*Referee 2 Role/Title

*Referee 2 Organisation

*Referee 2 Professional Registration No.

*Referee 2 ARTP Membership No.

*Relationship to applicant

*Referee 2 Email Address

Section 8

Applicant Impact Statement

*What is your most significant contribution to respiratory and/or sleep science, and why?

Section 9

Declaration

I confirm thatThe information provided is accurate and completeI understand that Fellowship is awarded based on evidence providedI consent to my application being reviewed by the ARTP Fellowship Panel