Lytics in Practice - Application Form

WE ARE NO LONGER ACCEPTING APPLICATIONS FOR THIS PROGRAM

Applications by Residents and nominations of Junior Faculty will be reviewed by the Lytics in Practice Faculty. Selection criteria include but are not limited to the following:


	The Lytics in Practice Scholarship for Residents is available to second-year Residents of training programs in PGY 1-3 format, and to third-year Residents from training programs in PGY 2-4 or PGY 1-4 format
	Eligibility will be deadline-based; completed applications must be submitted by September 26, 2008. Incomplete applications will not be considered
	Application must include letter of recommendation from Residency Director/Associate Director
	Diversity in terms of residency program representation. Ideally there will be no more than 2 participants representing each institution; either 1 Resident and 1 Junior Faculty member, or 2 Residents. The maximum number of participants from an institution is 2. Junior Faculty may not participate without an accompanying Resident in a 1:1 ratio

If you are interested in and will be eligible for the Lytics in Practice Scholarship and workshops that will be held on Sunday, October 26, 2008 just prior to the 2008 ACEP Scientific Assembly in Chicago, IL, please apply now.

Applicant's name:

Institution:

Address of medical institution:

Phone 1:

- -

Phone 2:

- -

E-mail:

Residency year:

Medical school attended:

Name of Residency Director/Associate Director:

Residency Director’s/Associate Director's
e-mail:

Please briefly explain your interest in learning about using fibrinolytic agents in treating thrombotic emergencies in the Emergency Department.

Once your residency is completed, in what type of healthcare setting do you anticipate starting your career as an attending? (Please check all that apply)
	Community hospital Academic institution Tertiary care center Other

Prior to completing your residency will you have an opportunity to conduct a residency lecture, grand rounds, or other presentation to your colleagues?
	Yes No

Upon submission of your application, an e-mail will be sent to your Residency Director or Associate Director requesting a signed letter of recommendation, which must be written on institution letterhead. Your application is not complete without this letter. For more information about Lytics in Practice, please call 908-832-8166.

Members of the Lytics in Practice faculty identified in this web site will teach the workshop; not all faculty members will be available at all workshop sessions.

Contact Us	Refer a Colleague Privacy