International Fellowship Program

Application for an International Fellowship in Respiratory Care

Application Deadline—June 1, 2009

The following documents must be included with your application form to be considered for a fellowship:

Your current curriculum vitae (résumé/biographical data).
One letter of recommendation from the director of your institution verifying your plans to develop some type of training program in respiratory care and/or establish respiratory care as a separate health profession.
Two letters of recommendation specifically addressing your professional expertise and qualifications in support of your application.
A digital photograph of yourself

The text documents can be in the form of any Microsoft Word compatible format (.doc, .rtf, .txt) or Adobe Portable Document Fomat (PDF). A free online PDF conversion tool is available on the United States Library of Medicine’s National Institute of Health web site. The digital photo can be in any format.

Professional credentials and degrees must be indicated.

	Please complete the following information:
	Given Name:
	Family Name:
	Gender:	Male Female
	Credentials:
	Professional Title:
	Home Address:


	City:
	Country:
	Postal Code:
	Telephone:	(Country Code-City Code-Number)
	Home E-mail:

	Employer:	(Insitution/Hospital/University)
	Employer Address:


	City:
	Country:
	Postal Code:
	Fax:	(Country Code-City Code-Number)
	Work E-mail:

	Description of Current Position/Job Responsibilities:
	Have you previously applied to be an International Fellow?	Yes No

	Educational Background
	Highest Diploma/Degree:
	Year Received:
	University:

	Experience in Health Care (examples: nursing, pulmonary medicine, anasthesia, physiotherapy, critical/intensive care, academics, additional training or experience, etc.)


	Do you have a current passport? Yes No

	Have you previously traveled under a visa? Yes No

	Will you need an official letter of invitation if selected as an International Fellow? Yes No

	Have you previously traveled in the United States for professional training or other professional reason? Yes No If YES, please explain:


	Have you previously applied to be an International Fellow? Yes No

	What professional groups (physicians, nurses, physiotherapists, or others) currently perform respiratory care procedures in your hospitals and other institutions? This would include procedures such as airway care, aerosol therapy, oxygen therapy, mechanical ventilation, diagnostic testing, etc.


	Do you have a sincere interest in establishing a respiratory care training program in your institution, or in trying to establish respiratory care as a separate profession in your country? Yes No If YES, please explain:

	If YES, are you in a position to do so? Yes No If YES, please explain:


	Would you be willing to do a written follow-up report to the AARC within six months after your fellowship? Yes No

	Attach your curriculum vitae (résumé/biographical data), a letter of recommendation from your institution’s director, and two other general letters of recommendation below:
	Curriculum Vitae:
	Director’s Letter:
	Recommendation #1:
	Recommendation #2:

	Attach a digital photo of yourself below:
Photo:

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