Get Unmc Addiction Medicine Executive Fellowship Application

Completing the UNMC Addiction Medicine Executive Fellowship Application online is a crucial step towards your fellowship opportunity. This guide provides clear, step-by-step instructions to assist you in filling out each section of the application accurately and effectively.

Follow the steps to successfully complete your application.

1. Click the ‘Get Form’ button to access the application form and open it in your preferred document editor.
2. Begin by filling out the personal information section. Include your last name, first name, middle initial, street address, city, state, zip code, phone number, email address, and country of citizenship carefully.
3. Proceed to the professional education section. List the full names and addresses of your undergraduate college/university, medical school, and residency, along with the dates of attendance and graduation, as well as the degrees you have completed.
4. In the professional training and experience section, provide the names and complete addresses of institutions where you have received training, along with the nature of the experience or specialty, along with the corresponding dates.
5. Fill out the medical licensure section by listing all states where you hold a medical license or controlled substance numbers. Include the license numbers and controlled substance numbers as required. Also, indicate whether you possess a federal DEA number and the state in which it is registered.
6. Answer the questions regarding investigations or disciplinary actions, hospital privileges, and any arrests or charges in the past 10 years. If applicable, prepare to attach explanations for any 'yes' responses.
7. Provide details under the current employer information section, indicating whether you are currently employed, the name of your employer, and the contact information for your current supervisor.
8. Complete the references section by listing three individuals with their names, titles, addresses, and phone numbers who can attest to your qualifications.
9. Prepare your personal statement and CV on a separate sheet. Ensure that both documents are emailed to the provided address (addictionmed@unmc.edu).
10. In the schedule section, list all the days you will not be available, including weekends, holidays, and any conference or board commitments.
11. Read through the agreement statement carefully, sign, and date it, ensuring that all provided information is accurate and complete. Print your name clearly as instructed.
12. Finally, submit your application by following the designated submission instructions. Ensure all components are included and saved as necessary.

Start your application process now to take the next step in your career.