2026-27 Diagnostic Imaging Body Fellowship Application

2026-27 Diagnostic Imaging

Body Fellowship Application

Last Name*

First Name*

Degree*

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Email Address*

Citizenship*

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Date of Birth*

Gender*

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Ethnicity

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Please list your current visa type and status

Phone Number*

Phone

Fellowship Program

Please select the program you are applying for

Body Imaging

Please confirm that you have completed at least 1 year of Neuroradiology fellowship training.*

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Thank you for your interest, but you do not meet the fellowship requirements at this time.

Please email DIEducation@mdanderson.org if you have any questions.

Medical School Attended*

Please list the name of the medical school you graduated from.

Medical School Start Date*

Medical School End Date*

Current Status*

Please select your current professional status/title below.

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Please provide details on your title and duties your are completing as a Researcher/Other status.*

Postgraduate Education Training

Internship Program Completed*

Please list the name of the Internship program you completed.

Internship Program Start Date*

Internship Program End Date*

Residency Program Completed*

Please list the name of the Residency program completed.

Residency Program Start Date*

Residency Program End Date*

Fellowship Program Completed*

Please list the name of any completed fellowship programs.

Enter N/A if not applicable.

Fellowship Program Start Date

Fellowship Program End Date

Licensure exam history below.

Enter scores.

USMLE 1

USMLE 2ck

USMLE 2cs (if applicable)

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USMLE 3

COMLEX 1

COMLEX 2ce

COMLEX 2pe (if applicable)

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COMLEX 3

ECFMG

If applicable, enter certification number.

Professional Licenses

Training Permit Number*

If applicable, enter the permit number and the issuing state. N/A if not applicable.

State License Number*

If applicable, enter the license number and the issuing state. N/A if not applicable.

National Provider ID Number*

N/A if not applicable.

Additional Questions

Have you ever been convicted of a felony?*

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Have you ever been employed by the University of Texas MD Anderson Cancer Center?*

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Have you ever been employed by another University of Texas component or another agency of the State of Texas?*

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List agency and dates of service.

Has your license to practice medicine in the U.S. ever been denied, limited, suspended, revoked or not renewed?*

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Have any disciplinary actions been initiated or are any pending against you by any State Licensure board?*

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Has your Federal/State controlled substances or narcotics registration ever been limited, revoked, suspended or not renewed, voluntarily or involuntarily, and is such registration subject to any pending challenge?*

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DPS Controlled Substances Registration Number*

If applicable, enter the registration number. N/A if not applicable.

Have you ever held a Texas Medical License?*

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Have you enter held a training permit issued by the Texas Medical Board?*

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Disability Disclosure

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Supporting Documents

File Upload*

Please provide the following combined into one PDF file:

-Curriculum Vitae

-Personal Statement

-Photograph

-Letter of Good Standing from current program. Letter must include program start date and anticipated end date.

-Letters of Recommendation (3); the letters must support your fellowship application, official letterhead with original signatures, and must be dated within the last 6 months. The letters can be emailed by the third party to DIEducation@mdanderson.org.

NOTE - If selected to join the program, updated letter of good standing and letters of recommendation will be required. These must be dated within 6 months of the expected July 1 start date.

-Medical School Transcript

-Diploma of Highest Degree

-Certificate of Completion for US Program (Internship)

-USMLE and/or COMLEX Transcripts

-Fellowship Certificate of Completion (if applicable)

-ECFMG Certificate (if applicable)

-Any additional supporting documentation

If you have any issues attaching and/or submitting documents, please email them directly to DIEducation@mdanderson.org.

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