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Derek Harwood-Nash International Fellowship Application


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Derek Harwood-Nash International Fellowship Application

  1. 1. 0708 Derek Harwood-Nash International Fellowship Application 820 Jorie Boulevard • Oak Brook, IL 60523 • (630) 590-7741 • Fax: (630) 571-7837 ELIGIBLE APPLICANTS must have completed their formal radiology training (MD or equivalent) and have held a faculty position in an academic institution for no less than 3 and no more than 10 years. Please fill out the form, save it to your computer and send to as an e-mail attachment. . The following documents are also required to complete your application: (Signed documents must be faxed or mailed to arrive by the deadline). Deadline: July 1, 2007 • A copy of your curriculum vitae (please send this document as an e-mail attachment) • A letter from your home institution that describes what institutional needs will be met by study in North America • A letter from the national radiologic society of your country confirming current membership and/or attendance at its meeting in the past two years • An additional letter of reference • Proof of proficiency in English- a TOEFL or equivalent test score taken within the last two years or for applicants of countries where English is an official language, a letter attesting to your verbal fluency in English • 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: Last Name First 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 Home Phone Number Please indicate the medical societies to which you belong: Page 1 of 4
  2. 2. 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 2007): Start date Stop date 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: 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: Fiona Miller Senior Manager: International Relations and Education Radiological Society of North America 820 Jorie Blvd • Oak Brook, IL 60523 (630) 590-7741 • Fax: (630) 5710-7837 This form is available online at: Application forms should 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. Page 2 of 4
  3. 3. HOST INSTITUTIONS AND SPECIALTY AREAS RSNA DEREK HARWOOD-NASH INTERNATIONAL FELLOWSHIP 2007 Institution Specialty Brigham & Women's Hospital Boston, MA Abdominal imaging, Neuroradiology, Oncoradiology, MSK imaging, Mammography Children's Hospital, Boston, MA Pediatric Neuroradiology, Pediatric Head & Neck Radiology, All Pediatric subspecialties Children's Hospital of Columbus Columbus, OH Pediatric Radiology. Pediatric Interventional Radiology, Pediatric Neuroradiology, Pediatric US, Pediatric Body Imaging Columbia University Medical Center New york, NY Functional MRI, Neuroradiology, Pediatric Radiology, Nuclear Medicine/PET Emory University School f Medicine Atlanta, GA Abdominal Imaging, Neuroradiology Hahnemann University Hospital Philadelphia, PA Neuroradiology, Ultrasound, Cross- sectional Imaging Lahey Clinic Burlington, MA Abdominal Imaging, Mammography, Ultrasound, Magnetic Resonance Imaging, Mammography, Nuclear medicine & PET, Body Imaging Louisiana State University HSC: Shreveport, LA Interventional (non-vascular), Neuroradiology, Nuclear medicine, Cross-Sectional Imaging Mallinckrodt Institute of Radiology. St. Louis, MO Interventional Radiology Michigan State University, East Lansing, MI MRI, Neuroradiology, MSK, PET Thomas Jefferson University Hospital Philadelphia, PA Diagnostic Ultrasound, MRI, MSK Radiology University of Arkansas for Medical Sciences, Little Rock, AK Interventional Neuroradiology, CT PET, Pediatric Radiology University of Maryland Medical Center Baltimore, MD Thoracic & Cardiac Radiology, Trauma, Nuclear medicine PET-CT, MSK, Abdominal University of Michigan Ann Arbor, MI Thoracic Radiology, Thoracic Cardiovascular CT and/or MRI University of Virginia, Charlottesville, VA Chest, Abdomen, Pelvis, CT, Body MR, Non- vascular Invasive Procedures, Ultrasound Imaging Wake Forest University, Winston-Salem, NC Mammography/Women’s imaging, Interventional radiology Wayne State University/Detroit Medical Center, Detroit, MI Pediatric Radiology, Neuroradiology, Trauma Radiology, Body Imaging William Beaumont Hospital Royal Oak, MI Neuroradiology, Vascular/Interventional Radiology, Breast imaging Page 3 of 4
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