{"id":44,"date":"2004-08-20T15:03:53","date_gmt":"2004-08-20T19:03:53","guid":{"rendered":"https:\/\/www.bumc.bu.edu\/ophthalmology\/post-graduate-education\/fellowship-applications\/"},"modified":"2022-09-30T15:46:59","modified_gmt":"2022-09-30T19:46:59","slug":"fellowship-applications","status":"publish","type":"page","link":"https:\/\/www.bumc.bu.edu\/ophthalmology\/post-graduate-education\/fellowship-applications\/","title":{"rendered":"Fellowship Applications"},"content":{"rendered":"<p><strong>BOSTON UNIVERSITY AFFILIATED HOSPITALS<\/strong><\/p>\n<p><\/p>\n<p><strong>Application for Appointment to Ophthalmology Fellowship Program,<\/strong><\/p>\n<p><strong><br \/>\nFellowship:___________________Date to Begin:_____________O.F.M. No.:_________<\/strong><\/p>\n<p><strong><br \/>\nFULL NAME:__________________________________Soc. Sec. #:__________________<\/strong><\/p>\n<p><strong><br \/>\nPermanent Address:________________________________________________________<\/strong><\/p>\n<p><strong><br \/>\nPresent Address:__________________________________________________________<\/strong><\/p>\n<p><strong><br \/>\nTelephones: Home____________________________Work________________________<\/strong><\/p>\n<p><strong><br \/>\nCitizenship:_____________Date of Birth____________Place of Birth:___________<\/p>\n<p>If not a citizen of USA, ? Visa Type____________<\/strong><\/p>\n<p><strong><br \/>\nMilitary Service\/Commitments:________________________________________________<\/strong><\/p>\n<p><strong><br \/>\nIf graduate of Foreign Medical School, ECFMG Number________Date Issued_______<br \/>\n(include copy of certificate)<\/strong><\/p>\n<p><strong><br \/>\nPhysical Disability, if any__________________________________________________<\/strong><\/p>\n<p><strong><br \/>\nEducation &amp; Training: Dates\/Degree<\/strong><\/p>\n<p>\nCollege:___________________________________________________________________<\/p>\n<p>\nMedical School:____________________________________________________________<\/p>\n<p>\nInternship:________________________________________________________________<\/p>\n<p>\nResidency:_________________________________________________________________<\/p>\n<p>\nNational Board Total Test Scores: (Numerical Value and Percent)<\/p>\n<p>\n(include copies of results)<\/p>\n<p>\nPart I_________________ Date Taken____________________<\/p>\n<p>\nPart II_________________Date Taken____________________<\/p>\n<p>\nPart III________________ Date Taken___________________<\/p>\n<p><\/p>\n<h3>Licensure:<\/h3>\n<p>\nIf you have a full (not limited)Massachusetts license: Number_________Date Issued:________<\/p>\n<h3>Names and addresses of three references: (Please arrange to have letters send to address below:)<\/h3>\n<p>\n1.___________________________________________________________________________<\/p>\n<p>\n2.___________________________________________________________________________<\/p>\n<p>\n3.___________________________________________________________________________<\/p>\n<h3>Send this application and a full Curriculum Vitae to:<\/h3>\n<p><strong><br \/>\nEdward B. Feinberg, MD, Chairman<\/strong><\/p>\n<p><strong><br \/>\nDepartment of Ophthalmology<\/strong><\/p>\n<p><strong><br \/>\nBoston University Chobanian &#038; Avedisian School of Medicine<\/strong><\/p>\n<p><strong><br \/>\n85 East concord Street, 8th Floor<\/strong><\/p>\n<p><strong><br \/>\nBoston, MA 02118<\/strong><\/p>\n<p><strong><br \/><\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"<p>BOSTON UNIVERSITY AFFILIATED HOSPITALS Application for Appointment to Ophthalmology Fellowship Program, Fellowship:___________________Date to Begin:_____________O.F.M. No.:_________ FULL NAME:__________________________________Soc. Sec. #:__________________ Permanent Address:________________________________________________________ Present Address:__________________________________________________________ Telephones: Home____________________________Work________________________ Citizenship:_____________Date of Birth____________Place of Birth:___________ If not a citizen of USA, ? Visa Type____________ Military Service\/Commitments:________________________________________________ If graduate of Foreign Medical School, ECFMG Number________Date Issued_______ (include copy of certificate) Physical [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":42,"menu_order":12,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"_links":{"self":[{"href":"https:\/\/www.bumc.bu.edu\/ophthalmology\/wp-json\/wp\/v2\/pages\/44"}],"collection":[{"href":"https:\/\/www.bumc.bu.edu\/ophthalmology\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.bumc.bu.edu\/ophthalmology\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.bumc.bu.edu\/ophthalmology\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.bumc.bu.edu\/ophthalmology\/wp-json\/wp\/v2\/comments?post=44"}],"version-history":[{"count":2,"href":"https:\/\/www.bumc.bu.edu\/ophthalmology\/wp-json\/wp\/v2\/pages\/44\/revisions"}],"predecessor-version":[{"id":2040,"href":"https:\/\/www.bumc.bu.edu\/ophthalmology\/wp-json\/wp\/v2\/pages\/44\/revisions\/2040"}],"up":[{"embeddable":true,"href":"https:\/\/www.bumc.bu.edu\/ophthalmology\/wp-json\/wp\/v2\/pages\/42"}],"wp:attachment":[{"href":"https:\/\/www.bumc.bu.edu\/ophthalmology\/wp-json\/wp\/v2\/media?parent=44"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}