2026 International Fellowship City Host Application
Applications Accepted Jan. 1, 2026 - April 1, 2026
YOUR CONTACT INFORMATION
Name
*
First Name
Last Name
Title
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Will you be the City Coordinator?
*
Yes
No
MEDICAL DIRECTOR INFORMATION
Please indicate a medical director of respiratory care who will be willing to meet with the Fellows and informally discuss respiratory care in the United States.
Name
*
First Name
Last Name
Title
*
Institution
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
HOST CITY INFORMATION
The host city/metropolitan area that will be participating.
*
Indicate a hospital from the above city/metropolitan area that is willing to participate (List hospital name, number of beds, and contact person who will serve as an institutional host).
*
Indicate a school from the above city/metropolitan area that is willing to participate (List school name, type of program (one-year, two-year, four-year) and contact person who will serve as in institutional host).
*
Indicate a home care organization from the above city/metropolitan area that is willing to participate (List the name of the organization, type of service, and contact person who will serve as an institutional host).
*
Indicate other institutions from the above city/metropolitan area that are willing to participate (SNF, specialty lab, hospice, group home, clinic, etc.) List the name of the institution, type of service, and contact person who will serve as an institutional host.)
*
Submit
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