Laughlin Fellowship Nomination

Laughlin Fellowship Nomination Form

To be eligible for the two-year Laughlin Fellowship, the nominee must be a current PGY II, III, or IV at the time of the application and be entering their final two years of training in July of the application year (can include fellowships).

Our aim is to create a cohort of Fellows who will maximally benefit from the two-year leadership curriculum prior to the start of their post-training careers.

Nominee

Name*
Degree(s)*
PGY*
If doing a fellowship*
Date Residency Began*

Nominee Institution

Facility*
University*

Address*

City, State, Zip*
Country*
Work Phone*

Nominee Residence

Address*

City, State, Zip*
Country*
Home Phone*
Mobile Phone*
Email*

Nominator

Name*
Degree(s)*
Title*
Work Phone*
Email*

Required documents

: PDFs only
Personal Statement*
CV/Resume*
Letter of Nomination*: NOTE: Only one letter of nomination will be considered by the current training director or designee. If fellows are entering into a new program in July, we require a brief letter of support from the new residency training director along with a nomination letter from the previous residency training program director.

NOTE: Each separately accredited sponsoring institution may submit only one nomination.

NOTE: Candidates may be nominated for either the PRITE or Laughlin Fellowship, not both in the same year. Those selected as a PRITE or Laughlin Fellow may not apply for the other fellowship in future years.

DEADLINE: Applications due by: May 15th of each calendar year