department of otolaryngology-head and neck surgery

Fellowship Application

Head and Neck Oncologic and Reconstructive Surgery Fellowship
Medical University of South Carolina

Application check list:
1.Completed application form below
2.Updated curriculum vitae attached below
3.Three letters of recommendation.  One letter must be from your program chair and at least one letter must be from a member of the American Head and Neck Society. (You may download them below or have them mailed.)
4.(Optional) One 2 x 2 color or B&W photograph
5.Onsite interview
Personal Information
Pre-Medical Education
Pre-Medical Education 2 (Optional)
Pre-Medical Education 3 (Optional)
Medical School
Medical School 2 (Optional)
Internship
Internship 2 (Optional)
Residency
Residency 2 (Optional)
Fellowships
Fellowships 2 (Optional)
Board Examination
USMLE
ECFMG
Certification
Honors
Medical Society Membership
References
One reference should be from a member of the American Head and Neck Society and one from either your department chairperson or program director. If you are not attaching the letters to this form, please request the letters to be sent directly to:
Ann Durgun
Division of Head and Neck Oncologic Surgery
Department of Otolaryngology/Head and Neck Surgery
135 Rutledge Avenue
PO Box 250550
Charleston, SC 29425
843-792-0719
Personal Statement
*
Publications
Curriculum Vitae
*
(Optional)
Fields marked with * are required. Enter N/A if not applicable.