Fellowship Programs: Application
Application
Last Name *
First Name *
Middle Name
Building/House Number
Street Name
City
State/Province
Country
Email *
Telephone - Home
Telephone - Work
Country of Citizenship *
Fellowship(s) to which you wish to Apply *
ABDOMINAL/BODY IMAGING
BODY INTERVENTIONAL
CARDIOTHORACIC
CARDIAC MRI
MUSCULOSKELETAL IMAGING
DIAGNOSTIC NEURORADIOLOGY
INTERVENTIONAL NEURORADIOLOGY
EMERGENCY RADIOLOGY
OBSTERICAL/FETAL IMAGING
PEDIATRIC RADIOLOGY
If selecting more than one, please select a maximum of two.
Of the Fellowships You Wish to Apply For, Which is Your First Choice?
If selecting more than one, please select a maximum of two.
Of the Fellowships You Wish to Apply For, Which is Your Second Choice?
If selecting more than one, please select a maximum of two.
Desired Start Date (month)
Desired Start Date (year) Medical School Training
Name of Medical School *
Country of Medical School *
Start Date
Month
Day
Year
Completion Date
Month
Day
Year
Degree Conferred
eg. MD
Date on Which Degree was Conferred
Month
Day
Year
I Have Taken and Passed Multiple Medical Licensing Examinations
Licensing Exam
eg, LMCC, USMLE Do not list attempted exams, only exams which have been successfully completed/passed
Date of Exam
Month
Day
Year
Residency TrainingProgram Type *
Radiology
Neurology
Neurosurgery
Obstetrics and Gynecology
Name of Institution or University *
City
State/Province
Country *
Years Attended From
Month
Day
Year
Years Attended To
Month
Day
Year
Certification Conferred
(eg. FRCPC)
Date of Certification
Month
Day
Year
I Had Multiple Residencies
I Have Had Fellowship Training
List of Referees
Name 1
Name 2
Name 3
UploadsPersonal Letter of Interest/Intent *
Letters MUST be specific for the sub-specialty fellowship
Files must be less than 100 MB.
Allowed file types: pdf.
Personal Letter of Interest/Intent (for 2nd fellowship program if applicable)
Letters MUST be specific for the sub-specialty fellowship
Files must be less than 100 MB.
Allowed file types: pdf.
Letters of Reference (Optional)
Applicants can upload letters of reference here, however applications will not be complete until the letters of reference are sent directly to radiology.fellowship@ucalgary.ca DIRECTLY by the referee.
Files must be less than 100 MB.
Allowed file types: pdf.
Curriculum Vitae *
Files must be less than 100 MB.
Allowed file types: pdf.