University of Colorado Emergency Medicine Fellowship Application for Military Candidates

Thank you for your interest in the University of Colorado Emergency Medicine Fellowship Program. Please fill out the below application form completely. Following this, you will need to attach 2 additional items: 1. CV 2. Personal Statement (consider including items such as your interest in the fellowship of your choice and why, a description of prospective projects, and where you see yourself in five years). Additionally, please submit two Letters of Recommendation (one must be from your current Residency Director). Letters of Recommendation will be submitted separately here: http://bit.ly/2E77hqs.

APPLICANT INFORMATION

Fellowship Applying For:*

Select or enter value

First Name:*

Last Name:*

Degree(s):*

Preferred Email:*

Preferred Phone Number:*

Country of Citizenship:*

EDUCATION, TRAINING, & LICENSURE

EM Residency Program Name:*

EM Residency Format:*

PGY 1-3

PGY 2-4

PGY 1-4

Residency Program Graduation Date:*

ABEM Status*

Will you be American Board of Emergency Medicine board eligible or certified in Emergency Medicine by the July 1 fellowship start date?

Certified

Eligible

N/A

Active Medical Licenses (if applicable):

FILE ATTACHMENTS

File Attachments*

1. CV 2. Personal Statement (consider including items such as your interest in the fellowship of your choice and why, a description of prospective projects, and where you see yourself in five years). Additionally, please submit two Letters of Recommendation (one must be from your current Residency Director). Letters of Recommendation will be submitted separately here: http://bit.ly/2E77hqs.

Drag and drop files here or

Send me a copy of my responses

Privacy Notice|Report Abuse