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Derek Harwood-Nash International
Fellowship Application
820 Jorie Boulevard • Oak Brook, IL 60523 • (630) 590-7741 • ...
I would like to study at the following institution(s) [if more than one, please list them in order of priority]:
1)
2)
3)
...
Institution Specialty
Children's Hospital, Boston Pediatric Neuroradiology, Pediatric Head &
Neck Radiology
Brigham & Wome...
Institution Specialty
(UCSF) Imaging, Cardiothoracic, Neuroradiology,
Neurointerventional Nuclear Medicine
Univ of Massach...
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Derek Harwood-Nash International Fellowship Application

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Derek Harwood-Nash International Fellowship Application

  1. 1. 0506 Derek Harwood-Nash International Fellowship Application 820 Jorie Boulevard • Oak Brook, IL 60523 • (630) 590-7741 • Fax: (630) 590-7707 ELIGIBLE APPLICANTS must have completed their formal radiology training and have held a position for 3 to 10 years in an academic institution. Please fill out the form and attach/ enclose the following: Deadline: July 1, 2005 • Your curriculum vitae • A letter from your home institution that describes what institutional needs will be met by study in North America • Two letters of reference, one of which is from the national radiologic society of your country confirming current membership and/or attendance at its meeting in the past two years • Proof of proficiency in English- a TOEFL or equivalent test score taken within the last two years • A documented list of academic productivity, research, and involvement in trainee education. • A 500-word personal statement (see page 2) Please provide the following information: Name Mailing Address Name of Home Institution Institution Phone Fax Home Phone E-mail Date of Birth Name of Medical School Graduation Date Location of Residency Training Completion Date Location of Additional Training Completion Date Emergency Contact Phone Number Fax Number Please indicate the medical societies to which you belong: Indicate your language fluency: Languages I speak Languages I read Languages I write Please give us your proposed dates for the start and end of this fellowship course of study (in 2005): Start date Stop date Page 1 of 4
  2. 2. I would like to study at the following institution(s) [if more than one, please list them in order of priority]: 1) 2) 3) Please indicate your area of special interest in radiology: Please briefly describe your responsibilities at your teaching institution: Name, address, and fax number for your department’s training director: Please give any other information you believe would assist the Committee on International Relations and Education in its selection: Name and addresses of three references; please note that one of these should be from a member of the national radiologic society in your country: 1) 2) 3) Provide a 500-word personal statement that covers the following points: • Specific educational needs and objectives that can be met only by a course of study in North America • Specific plans for using the knowledge and experience gained to benefit and improve the practice of radiology in your home institution and radiologic community Please note that your personal statement is an important part of your application Personal Statement: Completed applications should be sent to: Barry B. Goldberg, MD, Chairman Committee on International Relations and Education Radiological Society of North America 820 Jorie Blvd • Oak Brook, IL 60523 (630) 590-7741 • Fax: (630) 590-7707 cire@rsna.org This form is available online at: www.rsna.org/international/CIRE/dhnash Applications may be submitted as email attachments, but the application will not be considered complete unless the supporting documents are received by fax or mail by the JULY 1 deadline. HOST INSTITUTIONS AND SPECIALTY AREAS RSNA DEREK HARWOOD-NASH INTERNATIONAL FELLOWSHIP 2003 Institution Specialty University of Alabama at Birmingham Neuro-Radiology, Ultrasound, Body Imaging (CT-MRI) Page 2 of 4
  3. 3. Institution Specialty Children's Hospital, Boston Pediatric Neuroradiology, Pediatric Head & Neck Radiology Brigham & Women's Hospital CT, MRI, Ultrasound, Abdomen, Chest, Bone, Angio/IR, Breast, Nuclear Med, Oncoradiology, Neuroradiology, Cardiovascular, Informatics Weill Cornell Medical Center Neuroradiology, interventional, thoracic imaging, nuclear medicine, womens imaging, physics Cincinnati Childrens Hospital Pediatric Radiology Univ of Florida HSC/Jacksonville Body Imaging, Musculoskeletal Indiana University All subspecialties University of Iowa Health Care MRI, CT, US, musculoskeletal imaging, breast imaging, neuroradiology Louisiana State University Medical Center MSK, MRI, Interv. Radiology, Abdominal Imaging, Neuroradiology, Cardiothoracic & Nuclear Medicine Lahey Clinic Abdominal Imaging, Mammography, Ultrasound LSU Health Sciences Center Angiography, Vascular stents, Neurointerventional , Image-guided nonvascular interventions, cross sectional imaging (CT-MRI-Nuclear Medicine- Ultrasound) Mount Sinai School of Medicine Neuroradiology, ENT Radiology The University of North Carolina at Chapel Hill Thoracic Radiology, Pediatric Radiology, Breast Imaging Ochsner Clinic Foundation Ultrasound Wayne State University Pediatric Radiology, Neuroradiology, ER- Trauma Radiology University of Pittsburg Abdominal Imaging, Nuclear Medicine, PET, Neuroradiology Stanford University School of Medicine MRI, Advanced CT, 3D Imaging, All clinical subspecialty areas e.g. neuro cardiovascular, interventional. mammography, etc University of Arkansas for Medical Sciences MRI Head & Body, PET Scanning, Pediatric Intervention Thomas Jefferson University Hospital Ultrasound, MRI University of California-San Francisco Musculoskeletal, Interventional, Abdominal Page 3 of 4
  4. 4. Institution Specialty (UCSF) Imaging, Cardiothoracic, Neuroradiology, Neurointerventional Nuclear Medicine Univ of Massachusetts Medical Center Vascular & Interventional radiology, Body/Neuro Imaging Hospital of St. Raphael-Yale Univ School of Medicine Neuroradiology, MR UMDNJ-New Jersey Medical School UMDNJ-Robert Wood Johnson Medical School Interventional Radiology, Neuroradiology, Medical Education University of Southern California-Keck School of Medicine Neuroradiology MCW-Medical College of Wisconsin Interventional Neuroradiology Robert C. Byrd Health Sciences Ctr-West Virginia University Abdominal MRI Yale University School of Medicine MRI, Musculoskeletal, Breast Imaging University of Pennsylvania Neuroradiology, Chest & Body Imaging, Interventional Radiology University of California, Davis CT Imaging, Neuroradiology University of Virginia All subspecialties UCSD Medical Center Interventional Radiology, Body Imaging, MRI Page 4 of 4

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