Transfusion Medicine Fellowship
Application Form

We accept applications for the fellowship approximately 24 months preceding the start of the fellowship.

Required Documents:

Updated Curriculum Vitae (CV)
Photo
Cover letter and/or personal statement
USMLE Scores (If applicable, ECFMG Certificate)
Three letters of recommendation need to be emailed by the recommender directly to the program coordinator, Rachael (rjacinto@stanford.edu).

Please submit an online application and all required documents.

Mrigender Virk, MD

Clinical Assistant Professor of Pathology

Director, Transfusion Medicine Fellowship Program

Email: msvirk@stanford.edu

Rachael Alegre Buenafe-Jacinto

Fellowship Program Coordinator

Email: rjacinto@stanford.edu

First Name:

Last Name:

Email:

Phone number:

Phone

Have you used another name:

Date of Birth:

(mm/dd/yyyy)

Present Address:

(Street, City, State, Zip Code)

Gender:

Self Identification:

Please select all that apply.

Training period for which applying:

Medical Licensure:

Please list any states in which you hold a license to practice medicine. Please provide a license number. If an application is pending in a state, please write “pending.”

Board Certification:

Do you currently have any board certifications?

Undergraduate School:

Please list the College/University you attended

Other Experience:

In chronological order, list other educational experiences, jobs, military service, or training that is not accounted for above.

Name of Medical School:

Name of Residency Program:

Have you completed any other GME Fellowships:

At the time of your start with Stanford:

Will you be a US Citizen?

At your start date with Stanford:

Will you require a J1 Visa?

First Reference:

Please provide the individuals who will write your letters of recommendation: First, Last Name, Title

Second Reference:

First Name, Last Name, Title

Third Reference:

(First Name, Last Name, Title)

Comment Box:

Use comment box for any additional information:

File Upload

Please upload:

Photo
Updated Curriculum Vitae (CV)
Cover letter and/or personal statement
USMLE Scores (If applicable, ECFMG Certificate)

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Transfusion Medicine Fellowship Application Form

Transfusion Medicine Fellowship
Application Form