EMS Fellowship Application

EMS Fellowship Application

Thank you for your interest in our Emergency Medicine Fellowship Program!

First Name*

Last Name*

Phone Number*

Email*

Degree*

Country of Citizenship*

EM Residency Program Name:*

Residency Program Graduation Date:*

ABEM Status*

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Active Medical Licenses (if applicable):

EMS Eligibility Requirement*

Are you eligible based on the following information:

All required clinical education for entry into ACGME-accredited fellowship programs must be completed in an ACGME-accredited residency program, an AOA-approved residency program, a program with ACGME International (ACGME-I) Advanced Specialty Accreditation, or a Royal College of Physicians and Surgeons of Canada (RCPSC)-accredited or College of Family Physicians of Canada (CFPC)-accredited residency program located in Canada.

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Please upload the following:*

1. CV

2. Personal Statement (consider including items such as your interest in the fellowship, a description of prospective projects, and where you see yourself in five years)

3. Professional Headshot

4. Two Letters of Recommendation (one must be from your current Residency Director).

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