The Society of Critical Care Anesthesiologists Match Exception Violation Form - The Society of Critical Care Anesthesiologists

The Program Directors Advisory Council and SOCCA Board of Directors are committed to supporting a fair, equitable and successful match process for the candidates applying for the Critical Care Anesthesiology Fellowship programs. We have developed and supported match exception agreements to allow for the coordination of unique situations that can not be readily accommodated throughout the match. If after reviewing the criteria for match exceptions you feel that a program did not follow or uphold the policies of the agreement, please submit a request for inquiry through this form (below). If you would like to request a follow-up, please include your email address in the form or reach out to info@socca.org.

Reason for Request (choose all that apply)*

Program offered position(s) before the opening day

Program offered position(s) after the closing date

Program offered position(s) that did not meet one of the six criteria

Applicant accepted a position prior to opening day

Other

If you selected "Other" as the Reason for Request please provide additional information here:*

I am an:*

Program Director (or APD) of ACCM Fellowship

Program Director (or APD) of ACTA Fellowship

Program Director (or APD) of Anesthesia or Emergency Medicine Core Residency

Faculty in ACCM Fellowship Program

Program Coordinator

Resident Applicant (applying this cycle)

Current Fellow

Prefer not to specify

Other

Please provide details if possible (consider program name, program director(s) involved, applicant(s) involved, dates, etc).*

Would you like to receive follow-up regarding the findings of the inquiry?*

Yes

No, prefer to remain anonymous

If you would like to receive follow-up regarding the findings of the inquiry, please provide your email address and/or phone number.*

Would you be willing to speak with the SOCCA leadership regarding this matter (SOCCA PDAC Chair Erin Hennessey, Vice Chair Babar Fiza, and/or SOCCA President Mike Wall)?*

Yes

No, prefer to remain anonymous

If you would be willing to speak with the SOCCA leadership regarding this matter (SOCCA PDAC Chair Erin Hennessey, Vice Chair Babar Fiza, and/or SOCCA President Mike Wall), please provide your email address and/or phone number.*

Please note that this form will be reviewed by the SOCCA PDAC leadership and an inquiry will ensue. If we find that a violation did occur, we will communicate directly with the program director and chair regarding the findings and to explore ways to prevent this from happening in the future. We will keep the applicant’s information confidential and do not plan on pursuing action against applicants. Please note that the match exception process is a binding agreement between the program and the applicant. The process was developed through the SOCCA PDAC with approval of the SOCCA Board of Directors. The official match takes place through SFMatch which also enforces policies and regulations. If you feel a violation occurred unrelated to the match exception process please contact SFMatch through their processes.