The College of SIIM Fellows Application for Fellowship

Name(Required)

First Last

Honorary Degrees

Earned Degrees(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

FSIIM Sponsor #1(Required)

FSIIM Sponsor #2(Required)

List up to three(3) achievements you rate as your most significant:(Required)

Describe your contributions to medical imaging informatics(1000 word maximum).(Required)

Number of years as a member of SIIM(Required)

Which years?(Required)

A copy of your curriculum vitae is required for our files.(Required)

Max. file size: 128 MB.

Two letters of recommendations by sponsoring SIIM Fellows.(Required)

Drop files here or

Max. file size: 128 MB, Max. files: 2.

Optional: In addition, you may submit a separate list of references supporting your work in medical imaging informatics.

Max. file size: 128 MB.

The College of SIIM Fellows will select from zero to five members as SIIM Fellows annually. The new Fellows will be recognized during the SIIM Annual Meeting. The only correspondence you will receive is the acknowledgement of your application. Unsuccessful candidates may reapply.

The date of the next annual meeting, list of present Fellows and the full SIIM Bylaws can be obtained by visiting the SIIM website.

All application materials will be held in strict confidence by the COSF and become the property of SIIM.

Applicant's Signature(Required)

Date(Required)

Learning & Events

Featured Events

Featured Learning

Resources

Featured Resources

About SIIM

Featured

More

Become a member

If you share our passion to improve patient care through imaging informatics, join us!

If you share our passion to improve patient care through imaging informatics, join us!