DHN Application Form - Radiological Society of North America
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| |Derek Harwood-Nash International Fellowship Application | |
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|820 Jorie Boulevard ( Oak Brook, IL 60523 |
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|Deadline: July 1, 2013 |
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|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. |
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|Please email your completed application as well as the required documentation listed below to CIRE@. Signed documents may also be sent via email. |
|Alternatively, application materials may be sent via mail to the address noted above to arrive by the July 1 application deadline. |
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|A copy of your curriculum vitae |
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|A letter from your home institution that describes what institutional needs will be met by study in |
|North America |
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|A letter from the national radiologic society of your country confirming current membership and/or attendance at its meeting in the past two years |
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|An additional letter of reference (optional) |
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|Proof of proficiency in English- a TOEFL or equivalent test score taken within the last two years. |
|For applicants of countries where English is an official language, no TOEFL test is required, but the letter from your home institution must attest to your |
|verbal fluency in English. |
| |
|A documented list of academic productivity, research, and involvement in trainee education |
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|A 400-word personal statement (see page 2) |
|Please provide the following information: |
|Last Name | |Degree: | |First Name | |
| | |MD, PhD, Other | | | |
|Mailing Address | |
| | |
|Date of Board Certification | | |
|Name of Home Institution | |
| |Number of beds | |Number of radiology residents | |
|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 | |
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|Please indicate the medical societies to which you belong: |
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|How long have you held a faculty position in a teaching hospital? | |
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|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 2014): |
| Start Date | | End 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) | |
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|Please indicate your area of special interest in radiology: | |
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|Please briefly describe your responsibilities at your teaching institution: |
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|Name, address, and fax number for your department’s training director: |
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|Please give any other information you believe would assist the Committee on International Radiology Education in its selection: |
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|Provide a 400-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 |
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|Please note that your personal statement is an important part of your application. |
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|Personal Statement: |
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| |This form is available online at: |
|For further information, please contact staff at: |Derek_Harwood-Nash_International_Fellowship.aspx |
|CIRE@ | |
| |The application will not be considered complete unless the application |
| |form and all supporting documents are received in one of the following |
| |formats: |
| |PDF attachments, emailed to: CIRE@ |
| | |
| |Hard copies, mailed to arrive by July 1, 2013 |
| | |
| |Radiological Society of North America |
| |DHN – Attention: Department of International Affairs |
| |820 Jorie Blvd |
| |Oak Brook, IL 60523 |
| |USA |
Host Institutions and Specialty Areas
RSNA Derek Harwood-Nash International Fellowship
|Institution |Specialty |
|Brown University/Rhode Island Hospital |Pediatric Imaging, Body Imaging, Vascular & Interventional Radiology, |
|Providence, Rhode Island |Ultrasound, Thermal Oblation Services, Emergency Radiology, Nuclear Medicine |
|Case Western Reserve University & University Hospitals Case |Abdominal Imaging, Thoracic Imaging, Nuclear Medicine, Mammography, MRI, |
|Medical Center |Neuroradiology, Pediatric Imaging, Angio-Interventional Radiology, |
|Cleveland, Ohio |Musculoskeletal Imaging |
|Children's Hospital of Philadelphia |Pediatric Neuroradiology, Pediatric Thoracic and Abdominal Imaging, Pediatric |
|Philadelphia, Pennsylvania |Musculoskeletal Imaging, Pediatric Interventional Radiology |
|Children’s National Medical Center |Pediatric Radiology, Pediatric Ultrasound, Fetal Imaging, Pediatric Nuclear |
|Washington, D.C. |Medicine, Pediatric CT / MRI |
|Columbia University Medical Center |Functional MRI, Neuroradiology, Pediatric Radiology, Nuclear Medicine / PET |
|New York, New York | |
|Emory University School of Medicine |Abdominal Imaging, Neuroradiology |
|Atlanta, Georgia | |
|Hahnemann University Hospital |Neuroradiology, Ultrasound, Cross-Sectional Imaging |
|Philadelphia, Pennsylvania | |
|George Washington University Medical Center |Pediatric Imaging |
|Washington, D.C. | |
|Georgia Health Sciences University |Neuroradiology |
|Augusta, Georgia | |
|Indiana University School of Medicine |Abdominal Imaging, Neuroradiology, Breast Imaging, Nuclear Medicine, Pediatric |
|Indianapolis, Indiana |Radiology |
|Johns Hopkins Hospital and University |Pediatric Neuroradiology, High-end Pediatric MR Imaging, Pediatric Uroradiology,|
|Baltimore, Maryland |Pediatric Ultrasonography |
|Lahey Clinic |Magnetic Resonance Imaging, Mammography, |
|Burlington, Massachusetts |Nuclear Medicine & PET, Body Imaging |
|Louisiana State University HSC |Interventional (non-vascular), Neuroradiology, |
|Shreveport, Louisiana |Nuclear Medicine, Cross-Sectional Imaging |
|Mayo Clinic |Abdominal Imaging, Neuroradiology, Vascular Interventional Radiology, Nuclear |
|Rochester, Minnesota |Medicine, |
| |Thoracic Radiology |
|Mount Sinai School of Medicine |ENT Radiology, Hepatobiliary Disease, |
|New York, New York |Liver Cancer – Chemoembolization, |
| |ttrium 90, Radiofrequency Ablations |
| |Mammography/Breast Imaging, Neuroradiology, |
| |Pediatric Radiology/Ultrasound, Vascular and Interventional Radiology |
|Nationwide Children’s Hospital |Pediatric Radiology, Pediatric Interventional, |
|Columbus, Ohio |Pediatric Ultrasound, Pediatric MR & CT, |
| |Pediatric Oncologic Imaging |
|Thomas Jefferson University Hospital |Diagnostic Ultrasound, MRI, |
|Philadelphia, Pennsylvania |MSK Radiology |
|University of California, Irvine |Emergency Radiology, Cardiovascular and Thoracic Radiology |
|Irvine, California | |
|University of Florida |Cardiac Imaging |
|Gainesville, Florida | |
|University of Maryland Medical Center |Thoracic & Cardiac Radiology, Trauma, |
|Baltimore, Maryland |Nuclear Medicine PET-CT, MSK, Abdominal |
|University of Miami/Jackson Memorial Hospital |Abdominal Imaging, Interventional Radiology, Musculoskeletal Radiology, |
|Miami, Florida |Neuroradiology, Traum/Emergency Radiology |
|University of Michigan |Thoracic Radiology, |
|Ann Arbor, Michigan |Thoracic Cardiovascular CT and/or MRI |
|University of Rochester |Ultrasound, Body MRI & CT, Photoacoustic Imaging |
|Rochester, New York | |
|University of Texas MD Anderson Cancer Center |Vascular and Interventional Radiology, Body Imaging, Thoracic Imaging, Breast |
|Houston, Texas |Imaging, Musculoskeletal Imaging, Neuroradiology |
|University of Texas Southwestern Medical Center / Children’s |Pediatric Neuroradiology |
|Medical Center | |
|Dallas, Texas | |
|University of Virginia |Chest, Abdomen, Pelvis, CT, Body MR, |
|Charlottesville, Virginia |Non-Vascular Invasive Procedures, Ultrasound Imaging |
|University of Wisconsin School of Medicine and Public Health |Abdominal imaging, Community, MR and Chest, Neuroradiology, Musculoskeletal, |
|Madison, Wisconsin |Breast Imaging, Nuclear Medicine, Cardiovascular Imaging, Pediatric Imaging, |
| |Interventional, Imaging Sciences |
|Wake Forest University |Mammography/Women’s Imaging, |
|Winston-Salem, North Carolina |Interventional Radiology |
|Yale University School of Medicine |Body Imaging |
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Updated: December, 2012
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