Department of Anesthesia & Critical Care Department of Anesthesia & Critical Care
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Fellowship Application

For Training Period: July 1, 2013 to June 30, 2014

We are now accepting applications. To remain competitive, we encourage you to complete your application by 4/30/2012.

Please indicate the subspecialty area: *

  • Cardiothoracic Anesthesia
  • Critical Care Medicine
  • Pain Management

Name: *

  • First:
  • M.I.:
  • Last:

Address: *

  • Street:
  • City:
  • State:
  • Zip::
  • Country::

E-mail: *


Date of birth: *

/ /

Place of birth: *


Social security #: *

- -

Citizenship: *

  • U.S. Citizen
  • Not a U.S. Citizen
  • Please provide visa status

Undergraduate: *

  • Institution: *
  • Graduation Date: *

Medical school: *

  • Institution: *
  • Graduation Date: *

Honors and awards: *


Degree upon completion: *


Relative class rank: *


Internship: *

  • Institution: *
  • Completion Date: *

Residency: *

  • Istituito: *
  • Start: *
  • End: *

Hospital and Research Practical Experience: *


Please provide a personal statement that delineates your career plans and gives us a brief biography: *


Please attach you Curriculum Vitae: *


Please note - Before your application will be considered we must have the following:

  1. Completed Fellowship application
  2. Curriculum Vitae
  3. Hard copies of your USMLE Scores
  4. Copies of all ABA In-Training Exam scores
  5. Three letters of recommendation addressed to Theresa Cumming, Director of Operations

Please send additional documentation to::

  • Theresa Cumming, Program Coordinator
  • University of Chicago
  • Anesthesia & Critical Care
  • 5841 S. Maryland Ave. MC-4028
  • Chicago, IL 60637-1470
  • Telephone: 773-702-6842
  • Fax: 773-834-0063
  • Email: TCumming@dacc.uchicago.edu