University of New Mexico Neurosurgery Pre-Residency Fellowship Application Form

University of New Mexico Neurosurgery Pre-Residency Fellowship Application Form

This training program is not recognized by the ECFMG, therefore VISA Sponsorship is NOT available. Applicants must be a US Citizen or US Resident authorized to work in the United States.

You will need the following documents to complete your application:

•Personal Statement

•CV

•USMLE / COMLEX Scores

•Photo

•LORs

You will need two letters of recommendation. Applications missing the documents listed above, will be considered incomplete and will NOT be reviewed.

If you have any questions, please do not hesitate to contact our Program Specialist, Luisa Mariscal at LMariscal@salud.unm.edu

Name*

Current Address*

Email*

Phone*

Date of Birth*

Birth Place*

(City, State, Country)

Are you a US Citizen/Resident*

This training program is not recognized by the ECFMG, therefore VISA Sponsorship is NOT available. Applicants must be a US Citizen or US Resident authorized to work in the United States.

Select

Pre-Medical Education

Undergraduate Institution*

Undergraduate City/State/Country*

Undergraduate Degree/Field of Study*

Undergraduate Degree Date*

(Month/Year)

Do you have a graduate degree?*

Select

Graduate Institution*

Graduate City/State/Country*

Graduate Degree/Field of Study*

Graduate Degree Date*

Medical Education

Medical Education Institution*

Medical Institution City/State/Country*

Degree Type*

Select

Medical Education Degree Date*

(Month/Year)

Are you certified by the ECFMG?*

Select

ECFMG Number*

Only if medical school is outside of the US

Do you possess a full valid Medical License*

Select

Issuing State*

License Number*

Expiration Date*

Professional References

You will be requested to submit two letters of recommendation. Please list the names and titles of letter writers in the spaces below.

•Letters can be submitted via email by the writer or program coordinator.

•Letters can be attached or see below

•Letters can be addressed to Dear Program Director

•Letters must be submitted to Luisa Mariscal, Medical Education Program Specialist via email at LMariscal@salud.unm.edu. In the subject area of the email, please list the applicant name

Letter 1 Name, Title*

Letter 2 Name, Title*

Required Documents*

CV, Personal Statement, USMLE or COMLEX Scores (I, II CS, II CK, III), Photograph, LORs*

PDF files only

Drag and drop files here or

Application Submission

Review all attachments and information before submitting your application. You will not be able to make changes after submission.

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