Fellowship Application
Department of Dianostic Radiology
Personal Information
Name
*
First Name
Last Name
Email
*
example@example.com
Curriculum Vitae
*
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Fellowship Information
Preferred Start Date
*
July 2026
July 2027
Off cycle start (if you select this option, please email radiology.fellowships@dal.ca. This can only be accommodated if there is availability)
What subspecialty are you applying to?
*
Abdominal Imaging
Pediatric Radiology
What subspecialty are you applying to? FIRST CHOICE
*
Abdominal Imaging
Cardiothoracic Imaging
Interventional Radiology
Musculoskeletal Imaging
Neuroradiology
Pediatric Radiology
Personal Statement 1
*
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What subspecialty are you applying to? SECOND CHOICE (not required, just for those who are interested)
Abdominal Imaging
Cardiothoracic Imaging
Interventional Radiology
Musculoskeletal Imaging
Neuroradiology
Pediatric Radiology
Personal Statement 2 (this is only required for those applying to a second subspecialty)
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Are you sponsored by Saudi Arabia, Oman, or Kuwait?
*
Yes
No
Candidates who are sponsored must submit applications through the Dal Medix portal. Candidates will not be considered for a fellowship if applications are submitted through email or this form. Thank you!
I understand and will submit my application through the portal.
Country of citizenship/permanent residency.
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Medical Education
Medical School
*
Date range of medical education
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Copy of MD certificate
*
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Medical school transcript
*
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Postgraduate Training
Institution
*
Date range of residency
*
Program Director or Preceptor
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Copy of residency certificate (if already completed)
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One of the following certificates: MCCEE, MCCQE part 1, USMLE, NBME, ECFMG, or FLEX (if applicable*)
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*If the above named certificates are not applicable, please comment why below:
References
Please have your referee send references directly to radiology.fellowships@dal.ca
Name of Referee 1
*
Name of Referee 2
*
Name of Referee 3
*
I certify that my answers in this application are true and complete to the best of my knowledge. If this application leads to a Fellowship at Dalhousie University, I understand that false or misleading information in my application or interview may result in my release.
*
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