New Program Administrator / New Program Director Registration Form

Disclaimer: This information will be shared with the Faculty Affairs and Medtech offices in order to grant you IT access. 

Program Administrators are asked to complete this form to ensure that PGME has the required information regarding the appointment of the new Program Director, Assistant Program Director, Program Administrator, etc. 

If you are completing this form for a new Residency Program Director or AFC Fellowship Director, an approval letter from the Department Chair or Division Head is required. We suggest selecting the appropriate role from the list of roles below and reviewing and collecting the required information prior to completing the form. 

Please refer to the procedure outlined in the PGME Policy and Procedures on Appointing a Program Director and the Program Director Job Description.   

Submitter information

(if applicable)

Please select role
New Director

Department Chair PD Appointment Approval Letter Template 

Download the template to be completed by the Department Chair and upload it here.

Name of proposed program director
Title
Office Address
The new Program Director has a mentor/coach to orient them in the new role:

PGME will assign the new Program Director a mentor. The Vice Dean will discuss with the new Program Director at their orientation meeting.  

Outgoing Program Director  
New Residency Program Administrator, Fellowship Program Administrator or Education coordinator
Name of new residency program administrator, fellowship program administrator or education coordinator
Title
Office Address
Outgoing Residency Program Administrator, Fellowship Program Administrator or Education coordinator
New Other Roles
Name of new person assuming the role
Title
Office Address
Outgoing person in the role

Sign below