Application Form - Strategic Collaborations Unit

Thank you for your interest in the International Fellowship at the Mass General Brigham Department of Emergency Medicine. The program has the multiple tracks:

STRATUS International Fellowship in Clinical Simulation
International Fellowship in Emergency Department Leadership and Administration (PEDLA)
International Fellowship in Emergency Ultrasound
International Fellowship in Emergency Medicine and Critical Care Medicine
International Fellowship in Disaster Medicine and Healthcare Emergency Management

Please complete this application form and upload your supplemental application materials. If you have any questions, please email internationalfellowships@mgb.org.

Applicant Information

Full Name *

Date of Birth

Gender on Passport

Address

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Address Line 2

City

State / Province / Region

Postal Code

Country

Phone *

Email *

Program Track *

Anticipated Matriculation Date

Education

Highest Level of Education

University

Address

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Address Line 2

City

State / Province / Region

Postal Code

Country

Degree

Start Date

Graduation Date

Residency/Fellowship

If applicable

University

Address

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Address Line 2

City

State / Province / Region

Postal Code

Country

Start Date

Completion Date

Sponsoring Agency/Embassy

Agency/Embassy

Address

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Address Line 2

City

State / Province / Region

Postal Code

Country

Contact Name

Phone

Supplemental Materials

Please provide the following:

Resume/CV
Three Letters of Recommendation
Cover Letter detailing why you would like to be an International Fellow and your specific interest in the program track you are applying for.
Transcripts (Healthcare Education Transcripts)

Attachments

Click or drag files to this area to upload. You can upload up to 10 files.

Attestation

I certify that my answers are true and complete to the best of my knowledge.

Signature *

Date *

How did you hear about this Fellowship? *