Site Visit Preparation Form - American Head & Neck Society

ATC - Re-Accreditation Site Visit Preparation Form

Please complete the form below in preparation for your AHNS Re-Accreditation Site Visit.

Name of AHNS-Accredited Fellowship Program(Required)

Program Director's Name(Required)

First Last

Program Director's Preferred Email for Accreditation Correspondence(Required)

Please indicate any significant FACULTY changes (new hires or departures) your program has experienced since your last accreditation site visit.

Please indicate any significant changes to the FACILITIES utilized by your program since your last accreditation site visit.

Use this space to list any additional significant changes your fellowship program has experienced since your last acceditation site visit.

List the recent graduates of your fellowship (last 5 years) and where they went after completing your program.

Fellow Name

Year of Completion

Where they've gone