Clinical Fellowship Application

Fellowship Year you are applying for

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Personal Information

Last Name

First Name

Address

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone number

Current Immigration Status

N/A: US Citizen

Green Card Holder

Not applicable

Visa Holder

Other

Please specify your visa type and the date your visa was first issued.

Please explain.

Will you require a Visa?

Personal Statement

One file only.
5 MB limit.
Allowed types: pdf.

One file only.
3 MB limit.
Allowed types: pdf.

Medical School Transcript

One file only.
2 MB limit.
Allowed types: pdf.

Medical School Diploma

One file only.
5 MB limit.
Allowed types: pdf.

Verification of an ACGME-accredited residency

One file only.
1 MB limit.
Allowed types: pdf.

ECFMG certificate

One file only.
4 MB limit.
Allowed types: pdf.

USMLE Steps 1-3

One file only.
1 MB limit.
Allowed types: pdf.

ABR Board Certified?

Eligible

Certified

Photograph

One file only.
5 MB limit.
Allowed types: jpg, jpeg, png.

We require three letters of recommendation (one from either the chairperson of your present department or from the director of your residency program, and two from additional faculty members in your department) addressed to Erika Rubesova, MD Please have each reference letter emailed to pedradfellowship-coordinator@stanford.edu

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