Regulatory Affairs Professionals Society (RAPS) > Member Center > RAPS Fellows Program > RAPS Fellows Program Application

RAPS Fellows Program Application


I. Candidate Information
RAPS Member ID#
Mr.Ms.Dr.
First Name*	Last Name*	MI
Title*
Organization*
Address*
City*	State/Province	Postal Code*
Country*
Phone*	Email*

II. Education
Degree(s)*	Educational Institution*	Location*	Year*



III. Additional Professional Designations or Qualifications (e.g. RAC, certificates, etc.)
Designation	Year	Organization






IV. Work History
List chronologically, starting with your current position.		Please attach resume or CV
Total years of actual regulatory experience*		File Size: 2000KB Maximum File Types: .doc .pdf .txt
From Year to Year*	Organization*	Position(s) Held*




V. Management and Leadership Experience
Total years of management experience*
In approximately 300 words, please describe your past management and leadership experience. Your experience may include your accomplishments, responsibilities (e.g. global areas), supervision of employees, budgetary responsibilities, remote management/management through matrix organizations, liaison activities with executive staff, level of responsibility, decision making responsibilities (e.g. with regulatory agencies), etc. Attach a separate sheet if necessary.

Attach File File Size: 1000KB Maximum File Types: .doc .pdf .txt .zip
VI. Awards, Honors, Citations and Special Appointments
List top five achievements.
Name	Year	Organization






VII. Contributions to the Regulatory Community
In this section, please list the top five activities that show how you made contributions to the regulatory community. These activities may include speaking, publishing, mentoring, teaching and pro bono opportunities.
Contribution Type (e.g. speaker)	Year(s)	Description of Activity






VIII. Membership in Other Professional Organizations
Organization	Years Involved	Position Held (if applicable)






IX. Knowledge and Breadth of Regulatory Issues
A RAPS Fellow is expected to have Level IV experience as outlined in the Regulatory Affairs Professional Development Framework (www.raps.org/pdFramework/WhitePaper ). Level IV professionals are strategic and “innovative.” They assume a strategic lead role representing the regulatory perspective while proactively developing new and often innovative approaches for pursuing business objectives within the regulatory framework. Some of the most important facets of the Level IV professional’s scope of practice are responsibilities and tasks related to strategic planning and interfacing throughout the product lifecycle, both within the organization and with diverse external groups. Based upon a strong and extensive understanding of the role of the profession in the product lifecycle and the dynamics of regulatory processes, these professionals are also engaged in policy development within their organizations and with external groups. They typically are leaders and mentors within their organization and for the profession. At Level IV, professionals must be able to work effectively in multinational/multicultural environments. In 500 words or less, please provide examples of your knowledge, skills and abilities throughout the product lifecycle, strategic planning, premarketing , postmarketing and interfacing. Attach a separate sheet if necessary.


X. Additional Information
In this section, please provide any additional information that has not been asked above that you think is important for the Selection Committee to know in considering your application.

Signature
I certify that the information I have submitted is complete and correct to the best of my knowledge and belief. I understand and agree that any omission or misrepresentation in any statement or answer maybe considered sufficient reason for refusal of this application. I understand that I if I become a RAPS Fellow that I must maintain my membership in RAPS in order to maintain my Fellow status.

Signature *		Submit Date*





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