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)

APPLICATION FORM FOR ANNUAL LISTING OF FELLOWSHIPS IN PEDIATRIC SUB SPECIALTIES 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. 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 2000--2001 academic year must be typewritten and in the hands of the Publisher by October IS, 1998 (envelope enclosed). Publication of this listing will be in January 1999. 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 Endocrinology Metabolism __ AllergylImmunology Gastroenterology and NeonatallPerinatal Medicine __ BehavioraIlDevelopmental Nutrition __ Nephrology Pediatrics General Pediatrics __ Neurology __ Cardiology Genetics/Dysmorphology __ Pathology __ Child Development Hematology/Oncology __ PharmacologylToxicology Critical Care Immunology __ Pulmonology __ Developmental Disabilities Infectious Disease __ Radiology __ Emergency Medicine Medical Toxicology __ Rheumatology For categories not listed, a paid ad may be placed by contacting Periodical Advertising Sales Services at Mosby (314-453-4305).

APPLICATION Fellowship in (state category exactly as above) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ State ___________________________________ Ciry____________________________________ Institution (hospital/university) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Deadline (month, day, year) for application to your program, if applicable _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Fellowship, beginning in the academic year 2000--2001, to be available (month) _ _ _ _ _ _ _ _ _ _ _ _ _ __ Duration of appointment _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Postgraduate training required (1, 2, 3 years) _ _ _ _ _ _ _ _ _ U.S. citizenship required: Yes ___ No Director of training program _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Address

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Phone: _ _ _ _ _ _ _ ___

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 fonn. This form, or photocopies thereof. may be used instead of the application forms mailed in May 1998 to department chairmen for the January 1999 fellowship listing in The Joumal of Pediatrics. All forms must be retumed by October IS, 1998.

THE JOURNAL OF PEDIATRICS

SEPTEMBER

1998 23A