Application for the Michael J. Gaffey
Medical Student Fellowship in Pathology

Instructions
This form will allow you to submit your application electronically. Complete each field, click the Send button at the bottom of the page to submit.

Type in your name, e-mail address, mailing address and phone number below. This will appear in the header of the e-mail message sent to the Selection Committee.

Your Name:

Your Email address:

 

Please enter your mailing address and phone number below:

Your mailing address:

Your phone number and/or pager number:

Please answer the questions below with a brief statement:

Please indicate your current year and medical school:

What field(s) if any, are you considering for residency at this time (this is not a selection
criterion)?
 

What previous experience have you had in pathology and/or research?

What do you hope to gain professionally during this year-long fellowhip?

What sort of curriculum would you be interested in pursuing during the fellowship (i.e., special areas of emphasis, research, clinical diagnostic work, etc.)?

Indicate the best times for a personal interview.

Please send a copy of your transcript AND if available, scores from USMLE, Part I to Julia C. Iezzoni, M.D., Department of Pathology, Box 800214, UVA Medical Center or FAX to 434-982-6130, Attention Julia C. Iezzoni, M.D. Thank you!

Click the Send button below to send your application to the Selection Committee.