UNMC Neuroradiology Fellowship Application

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Thank you for your interest in our program. Please submit this completed application and hang onto your confirmation e-mail (that's how you can make changes later if needed). Then send the following to Tina Hunter:
- CV
- Personal Statement
- Copies of USMLE results
- 3 letters of recommendation (at least one from program director or chairman)
- Passport-sized photo of yourself
- Copy of ECMFG certificate if FMG

Send or e-mail above application materials to:
Tina Hunter
Fellowship Coordinator
UNMC Department of Radiology
981045 Nebraska Medical Center
Omaha, NE 68198-1045
thunter@unmc.edu
402-559-1018

Email *

Phone *

Desired Fellowship Start Date *

YYYY

Last Name *

First Name *

Date of Birth

YYYY

Address (Street) *

Address (City) *

Address (State) *

Address (Zip Code) *

Citizenship (Only US Citizens or Green Card Holders eligible to apply - FMG must supply ECFMG) *

US Citizen

Green Card

Foreign Medical Gradaute (FMG)

Required

Undergraduate Institution *

Undergraduate Graduation Date *

YYYY

Undergraduate Major *

Medical School Institution *

Medical School Graduation Date *

YYYY

Medical School Degree *

ECMFG Certificate # (FMG only - please also submit photocopy of ECFMG certificate)

ECMFG Certificate Date

YYYY

Internship / Transitional Year - Institution *

Internship / Transitional Year - Type of Training (e.g. Internal Medicine, Preliminary, Surgery) *

Internship / Transitional Year - Completion Date *

YYYY

Radiology Residency Institution *

Residency Anticipated Completion Date *

YYYY

Other Training / Education - Institution (1) (Other residency, PhD, Masters)

Other Training / Education - Type of Training (1)

Other Training / Education - Completion Date (1)

YYYY

Other Training / Education - Institution (2)

Other Training / Education - Type of Training (2)

Other Training / Education - Completion Date (2)

YYYY

Other Training / Education - Institution (3)

Other Training / Education - Type of Training (3)

Other Training / Education - Completion Date (3)

YYYY

USMLE Step 1 Score *

USMLE Step 1 Date *

YYYY

USMLE Step 2 CK Score *

USMLE Step 2 CK Date *

YYYY

USMLE Step 3 Result *

USMLE Step 3 Date *

YYYY

A copy of your responses will be emailed to the address you provided.

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