UTSW Non-Standard Training (NST) Program Application

UT Southwestern Non-Standard Training Program Application

Programs wishing to apply for NST status through ACGME must meet all the requirements and provide requested documents. ECFMG is relinquishing their role and programs who wish to recruit J-1 Visa holders must have NST status. Please review the ACGME’s Recognition Requirements for Sponsoring Institutions with Non-Standard Training Programs for J-1 Visa Sponsorship. Please also review the Non-Standard Training Program Policy.

Programs must provide documentation in accordance with the ACGME NST Program Requirements. All documents will be reviewed prior to approval and submission. Programs may not recruit applicants holding a visa prior to ACGME NST status is approval.

Program Information
Is this a new program to UT Southwestern?*

YesNo
CAP Application

Please be aware, a new program to UT Southwestern requires a CAP application and GMEC approval. Please be sure you have submitted this and followed those procedures.
Complement and Addition to Programs (CAP) Request Procedure & Application
Focus Area: *
Focus areas for non-standard training programs may be selected from an approved list. New focus areas that do not appear in the approved list are subject to approval by the ACGME.
ACGME Examples of Non-Standard Training Programs is a list of names that have been recognized for J-1 Visa Sponsorship. It is preferred for your program name to be one from this list, but you may request an alternative name to be approved. This list will provide you with the most closely related ACGME program which you must reference when submitting documents. Trainee assignments/ rotations must be limited to the most closely related ACGME program sites identified by the Sponsoring Institution and listed in ADS.
Related Program:*
Select closely related ACGME-accredited program.
Length of NST Program (in months):*
Length of NST Program (in months):*
Provide the rationale for the length of the NST program if longer than one year:

Expected Number of NST Trainees:*

	PGY 1	PGY2	PGY 3	PGY 4	PGY 5	PGY 6	PGY 7	PGY 8	PGY 9
Trainees per year

NST Program Mailing Address: *

Street Address

Street Address Line 2

CityState/ Province

Postal / Zip Code
You can often find the organization that provides your program recogniztion and also the number associated with that program within MedHub.

From the MedHub Home Screen, you will scroll down until you find Program Accreditation. After clicking on this, at the top of the first tab, Overview, should be the information that shows your program's accreditation information.
Is the NST program accredited?*

YesNo
If “Yes,” identify the accrediting body:
Only if applicable.
Is certification available to graduates of the NST program?*

YesNo
If “Yes,” identify the certifying body:
Participating Sites for NST Program:*
Include any other training site that is associated with the program:*

Program Personnel
There must be a single NST program director, from among the physician faculty members of the most closely related ACGME-accredited residency/fellowship program, who is responsible for the operation of each NST program. Programs must have adequate personal to support the program.
Program Director
Name*

First NameLast Name
Email*
Jane.Doe@UTSouthwestern.edu
Phone Number*
Office or UT Southwestern numbers only.
Specify any required qualifications of the NST program director:*
Please list the requirements for a program director to be eligible to hold the position, do not list the qualifications of the current program director.
Training Program Coordinator

GME titled PC only
Name*

First NameLast Name
Program Contact Phone Number*
Please enter the main phone number for this program.
Program Contact Email*
Please use the main email used to contact this program.
Primary/Core Faculty
List all faculty members other than the NST program director who have responsibility for education or supervision of trainees in the NST program: *
Example: Dr. John Doe, MBBS, MD, MPH; American Board of Internal MedicineFirst / Last / Degree / Participating Site (select); add entries as needed.

Training Information
Define the educational goals of the NST program: *
Describe NST trainee responsibilities for patient care, care management, and supervision during the NST program: *
Describe required educational experiences and didactic sessions in the NST program:*
Is this primarily a research program?*

YesNo
If “Yes,” describe how this NST program will provide advanced clinical training:
Does the NST program require experience in patient care procedures?*

YesNo
If “Yes,” define procedural experience requirements:
Define the prerequisite education and/or training for entry into the NST program:*
Describe supervision of trainees in the NST program:*
Describe the method(s) for assessment of NST trainees: *
Describe how personnel, clinical services, and other resources will be made available for the NST program without adverse impact on the education of residents or fellows in the Sponsoring Institution’s ACGME-accredited program(s): *
Should be Empty:

UT Southwestern Non-Standard Training Program Application