Visit us on Facebook icon-twitter.png     About FOEM           (331) 248-7799

General Competition Application Form

Apply for one of our competitions using the form below.

Fields marked with an "*" are required.

Applicant's Information

First Name:*
Last Name:*
Home Address:*
Zip Code:*
Phone Number:*
Year of Training:*
Dates of Training:*

Institution Information

Institution Name:*
Institution City:*
Institution State:*

Program Director's Information

PD's First Name:*
PD's Last Name:*
PD's Degree:*
PD's Title:*
PD's Address:*
PD's City:*
PD's State:*
PD's Zip Code:*
PD's E-mail:*

Competition Choice

Please choose the competition that you are applying for – only one competition per project is accepted.


**If applying to the CPC Competition, Faculty Discussant information must be listed below.  This information will be used to send blinded case abstracts to the Discussant, so please ensure that this is the home address (not the hospital) and the home/cell phone (not the hospital). 

Faculty Discussant Information
FD's First Name:
FD's Last name:
FD's Degree:
FD's Title:
FD's Address:
FDs' City:
FD's State:
FD's Zip:
FD's Phone
FD's Fax
FD's E-mail:

Project Information

Project Title:*
Project Authors:*

(list all authors and applicable titles such as DO, MD, RN, etc.  Principle Investigator should be listed last)

Official Presenter:*

(one presenter per project)


Electronic Signature

All persons meeting authorship criteria are listed as authors, and will certify that they have participated sufficiently in the work to take public responsibility for its content, including participation in the concept, design, analysis, writing, or revision of the manuscript. Furthermore, each author certifies that this material or similar material has not been and will not be submitted to any other publication before its appearance at the next national meeting of the American College of Osteopathic Emergency Physicians (ACOEP) without its prior, written approval. If this study has been or will be presented at any other national meeting, indicate the date of the meeting on a separate cover page.

I certify that any affiliations with or involvement in any organization or entity with any financial interest in the subject matter or materials discussed in this manuscript are disclosed below or in the cover letter. If none, state “none” below.

An institution’s human or animal subject review committee must approve all studies involving human or animal subjects. If your institution’s ethical research protocols exempt your study from such approval, state below. To maintain blinded peer review, do not include the name of the institution when identifying the review committee in the Abstract. Institutional review board approval or exemption has been completed.

Choose One:*


Upload only files pertaining to the competition you are applying for in the designated upload boxes below.

New Innovations in Emergency Medicine Doc
Case Study Poster Abstract
Research Paper Abstract
Research Paper
Research Poster Abstract
Oral Abstract
CPC Case History
CPC Diagnosis
CPC Supporting Doc

To prevent spam, please tell us:
What is 2 + 2 ?