Please choose which fellowship you wish to make a nomination for. Nominees for the PRITE Fellowships who intend to specialize in child psychiatry can mark "PRITE w/Child PRITE" to also be considered for the Child PRITE Fellowship.

Name*

PRITE Fellowship
Child PRITE Fellowship
PRITE w/CHILD PRITE Consideration

Name*

Degree(s)*

PGY*

Date Residency Began*

Facility*

University*

Address*

City, State, Zip*

Country*

Work Phone*

Address*

City, State, Zip*

Country*

Home Phone*

Mobile Phone*

Email*

Name*

Degree(s)*

Title*

Work Phone*

Email*

Ability to Work in Teams*

Select rating Fair Good Excellent Outstanding Not Able to Rate

Open-mindedness*

Select rating Fair Good Excellent Outstanding Not Able to Rate

Academic/Scholarly Activity Track Record*

Select rating Fair Good Excellent Outstanding Not Able to Rate

Lifelong Learning (in practice and mindset)*

Select rating Fair Good Excellent Outstanding Not Able to Rate

Believes in Continuous Improvement*

Select rating Fair Good Excellent Outstanding Not Able to Rate

Reasons why this fellowship would be a good fit for the candidate's career goals (500 characters max).*

By providing an endorsement of this candidate, I certify that if chosen the candidate will be supported by the residency in this endeavor and sufficient time provided for them to complete their writing and review assignments during the two-year appointment.

In addition, I certify that the program will agree to provide time for the fellow to attend meetings both in-person (approximately 12 days per year) and virtually. Specifically, residents/fellows will not be required to use vacation time or PTO for these activities.

Acknowledgement*

PDFs only

Candidate Letter*

CV/Resume*

Sample Questions*

Please remove all identifying information (questions are scored blindly)

Candidate Question Sign off*

Download document to be signed by Nominee

CHILD PRITE PD Sign-off Letter

Only if Adult Psychiatry Program Director wishes to nominate a current PGY 3 resident for CHILD PRITE (should include a brief statement of support from the Child Fellowship Director).