Stop. The neurohospitalist fellowship director must be a member of the department taking primary responsibility for the fellowship.

Participating Sites: Neurohospitalist fellowships may take place at any hospital affiliated with the sponsoring institution. Each participating site must provide documentation of an affiliation agreement with the sponsoring institution that grants the participating site authority to provide an educational experience for trainees under the oversight of the sponsoring institution.

List each participating site where clinical experiences take place during the neurohospitalist fellowship:

List the neurohospitalist fellows who have graduated in the last 2 years:

List the neurohospitalist fellows currently enrolled in the program:

List the neurohospitalist fellows expected to start the program in July of the coming academic year:

Provide a sample schedule that illustrates how the fellowship plans to accommodate multiple learners. A sample schedule is provided here. Note, in this example both learners are never on the same rotation at the same time, but that does not preclude this option if a rotation can provide a robust learning experience for two fellows simultaneously.

Provide an updated list of clinical educational experiences (i.e., rotations). List rotations, the site at which each occurs, and the number of months the fellow spends in each experience. Core clinical rotations should be specified as such. At least six months must be spent in core clinical rotations. A sample schedule is provided here:

*Learning goals and objectives should be clearly numbered in the box or document submitted with initial accreditation or biennial review. These numbers can then be used to identify goals and objectives in the list of clinical educational experiences.

Supervision: The program must provide a written policy regarding fellow supervision.

Moonlighting: The program must provide a written policy regarding fellow moonlighting.

Diversity, Equity, and Inclusion: The program must provide a written policy describing practices that promote an equitable and inclusive learning and work environment.

Please make your check payable to the Neurohospitalist Society and mail to:

The Neurohospitalist Society
Attn: Amanda Pacia
1100 Melody Lane, Suite 2003
Roseville, CA 95678

*** Payment must be received by September 1 in order to process your application.