Letter of Intent (LOI) Template Please:

1.Prepare this Letter of Intent on your Institutional Letterhead, 2.Sign the letter, and save it in PDF Format, 3.Complete the attached LOI Information Package, 4.Send the Letter and LOI Package via email to [email protected] (write “ABAM Foundation LOI” in subject line) by September 8, 2010

[date]

Richard D. Blondell, M.D. Chair, Training & Accreditation Committee The ABAM Foundation Department of Family Medicine, SUNY at Buffalo 462 Grider Street, Room CC-175 Buffalo, NY 14214-3021

Dear Dr. Blondell,

As the [enter title as institutional official], I commit the [institution] to seek program accreditation with the American Board of Addiction Medicine (ABAM) Foundation for the start of an Addiction Medicine residency by July 1, 2011. If accredited by the ABAM Foundation, we ultimately will work with the Foundation to seek accreditation by the Accreditation Council for Graduate Medical Education (ACGME). The [institution] has [X number of other medical specialties – give examples] accredited by ACGME and we have a long track record of accomplishments in areas of [brief list of related capabilities]. Our proposed Program Director will be [PD name], who is well qualified with [summary of credentials]. Other participating faculty will be [faculty list with credentials]. We have commitments from various addiction treatment settings [describe extent of commitments; describe facilities and settings] for resident rotations. If invited to apply, we will submit a Program Accreditation Application Form (PAAF) for ABAM Foundation Accreditation by November 1, 2010. We have the experience [describe recruitment strategy] to recruit at least one Addiction Medicine Resident by July 1, 2010. We further have institutional resources and financial commitments [describe specifics] planned to support the startup of the program. It is understood that if we become an ABAM Foundation accredited program and are among those selected for financial support, and if the State University of New York at Buffalo receives the grant award for which it will apply on behalf of the ABAM Foundation, we agree to contract with the SUNY at Buffalo for supplemental startup support up to $100,000 over two years for program expenses that do not supplant institutional resources described above. We look forward to the opportunity to be a full participant in this national initiative to establish Addiction Medicine Residency training programs. Sincerely, [institutional official name] [institutional official title]