Application Form For Annual Listing Of Fellowships

APPLICATION FORM FOR ANNUAL LISTING OF FELLOWSHIPS IN PEDIATRIC SUBSPECIALTIES PEDIATRIC ACADEMIC TRAINING PROGRAMS (Not listed: pediatric internships and residencies [PL 1, 2, and 3] and surgical subspecialties) Applications are sent only to the individual (herein called Director) responsible for the Postgraduate Program in institutions approved for pediatric training by The Pediatric Residency Review Committee. Publication of the fellowship listing is in January for the academic year beginning 18 months after publication. A fellowship listed in the January 2001 issue will begin in the month specified in 2002. 1. It is the responsibility of the Director to distribute application forms to persons responsible for the subspecialty services that have available fellowships, including programs at all affiliated hospitals and institutions. 2. A separate application is required for each subspecialty fellowship to be listed. 3. Applications for listing fellowships available beginning in the 2002–2003 academic year must be typewritten and in the hands of the Publisher by October 16, 2000 (envelope enclosed). Publication of this listing will be in January 2001. For confirmation that the Publisher has received your forms, we suggest that you return them by certified mail. Mail to: MOSBY, INC. PERIODICAL EDITING DEPARTMENT 11830 WESTLINE INDUSTRIAL DRIVE ST. LOUIS, MO 63146-3318 4. ALL applications from an institution are to be mailed by the Director of the institution or pediatric department. Fellowship in (check one only): ___ Adolescent Medicine ___ ___ ___ ___ ___ ___ ___ ___

Allergy/Immunology Cardiology Child Abuse Child Development Critical Care Developmental/Behavioral Pediatrics Developmental Disabilities Emergency Medicine

___ ___ ___ ___ ___ ___ ___ ___ ___

Endocrinology Gastroenterology and Nutrition General Pediatrics Genetics/Dysmorphology Hematology/Oncology Immunology Infectious Disease Medical Toxicology Metabolism

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Neonatal/Perinatal Medicine Nephrology Neurology Pathology Pharmacology/Toxicology Pulmonology Radiology Rheumatology Sports Medicine

For categories not listed, a paid ad may be placed by contacting Periodical Advertising Sales Services at Mosby (314-453-4337).

APPLICATION Fellowship in (state category exactly as above) State ————————————————————————————————— City Institution (hospital/university) Deadline (month, day, year) for application to your program, if applicable Fellowship, beginning in the academic year 2002–2003, to be available (month) Duration of appointment Postgraduate training required (1, 2, 3 years) ——————————————— U.S. citizenship required: Yes ______ No ______ Director of training program——————————————————————— Phone: ——————————— Fax: ________________ Address ____________________________________________________________________________________________ Certification by Chair of Pediatrics or Director of training program: The above-listed fellowship is approved by our institution and is designed primarily for training purposes and not for services per se. Date ———————————————— Signature ———————————————————————— Sample application form. This form, or photocopies thereof, may be used instead of the application forms mailed in May 2000 to department chairmen for the January 2001 fellowship listing in The Journal of Pediatrics. All forms must be returned by October 16, 2000. 22A AUGUST 2000

THE JOURNAL

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