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Society of Interventional Radiology Fellowship Application
3975 Fair Ridge Drive, Suite 400 North, Fairfax, VA 22033 Email: Membership@SIRweb.org

Instructions and Information

This is the online SIR Fellowship application.  The Fellows' Affairs Committee will consider and review all completed applications.  A complete application consists of:

  • this completed and submitted form. You will be able to save your progress with this online application and will be able to review your application before submitting.

  • a copy of your CV. You may upload this document within the form.  Please name your CV file as your last name (eg JONES_CV).
  • a cover letter that includes documentation supporting the criteria that you are applying under.
  • Photocopy of your Board Certificate
  • 2 letters of recommendation from current SIR Fellows.  Please enter their name in the application. You may forward this link to them: http://www.tfaforms.com/283150.

To be considered for induction at the Annual SIR Fellows' Business Meeting and Dinner, all applications must be completed by December 31st of the calendar year prior to the meeting.


Contact the SIR Membership Department at Membership@SIRweb.org with any additional questions.

General Applicant Information






Categories of Fellowship

Requirements for Active or Associate Fellowship

  • Applicants shall be current SIR Active or Associate members of the Society who have made significant contributions to the field of Interventional Radiology and to the Society.
  • Fellow candidates shall have been a practicing member in good standing of the Society for at least eight contiguous years. This does not include membership during "member-in-training" years.
  • The candidate shall have made a significant contribution to the field of Interventional Radiology as well as contribution(s) to the Society as determined by the policy set forth by the Fellows' Affairs Committee.  When evaluating candidates for Fellowship, the Fellows Affairs' Committee shall review the totality of the candidate's contributions on behalf of Interventional Radiology and the Society.  Fellowship shall be awarded based on a long and consistent history of activities.
Individuals practicing outside of the United States shall have the option of applying as an 
Active or Associate Fellow.

Click here to review more information about the criteria and requested supported documentation. 

CURRENT PRACTICE INFORMATION







EDUCATION
School City State Graduation Year Degree(s)
Undergraduate
Other Graduate
Medical School

INTERNSHIP AND RESIDENCY(IES)

























FELLOWSHIP








Page 3

SPECIALTY BOARD CERTIFICATION/RADIOLOGICAL QUALIFICATIONS

Primary Board Certification Name of Specialty Board Year of Certification
1.
2.
3.

CURRENT MEDICAL LICENSURE

State License Number Date of Certification
1.
2.

PAST PRACTICE ACTIVITIES

Hospital City, State Title Hrs/W Dates: From/To


PROFESSIONAL SOCIETIES



Please use the spaces below to detail your membership and offices held in all professional societies and associations.

Society/Association Type of membership/ office Dates: From/To
Other Qualifications

COMMITTEE/ANNUAL MEETING INVOLVEMENT



SPONSORSHIP

Supporting letters from current SIR Fellows are very important components of the nomination package. As a general rule, more weight will be given to letters that provide substantial information as opposed to a brief or pro-forma letters. Sponsors should be encouraged to provide detail in their letters of your accomplishments. Although at least two letters are required, more are certainly allowed, particularly if they document significant or unusual experience, or service not specifically spelled out in this document, but felt by the nominee to be applicable.

Sponsors must provide a letter of recommendation by using SIR's online Letter of Recommendation form found here: http://www.tfaforms.com/283150

It is your responsibility to encourage the submission of your letters.

Name of Fellow/Sponsor Institution Sponsor's Email address
1.
2.

APPLICANT FULFILLS WHICH OF THE THREE CRITERIA:


Cover Letter info
The Fellow's Committee requests that you submit a letter in support of your application outlining your qualifications.  In evaluating candidates for Fellowship, the committee will review the totality of the candidate's contributions on behalf of Vascular and Interventional Radiology.

It should be understood by the candidate that Fellowship will be awarded for a long and consistent set of activities.  The items in this section should be looked at as general guidelines. They do not guarantee that a nominee will be granted fellowship. They are provided as examples in an attempt to provide general direction and consistency to the review process.


If you are applying under Criteria 1:
List at least eight of the significant papers.  For each paper, include the following information:
- Title
- Publication
- Date of Publication
- Authors
- Your Role in the Publication (eg, primary author, primary author supervising a fellow/resident)
 
Please describe the research with which you have been involved. Include a list of the first author significant publications on interventional subjects that have been published in peer-reviewed journals and additional publications which you feel are of importance.

If you are applying under Criteria 2:
List the month/year and total duration of time you spent in full-time supervision and training fellows and residents in interventional radiology.  This cumulative time must be at least eight years.  Letters of verification for each program listed must be supplied by the head of that department.  Include the following information for each program.
- Program name
- Department
- Title/Responsibilities
- Start Date
- End Date
- Time in this position (number of years and months)
- % of practice time devoted to teaching IR (# of hours/week devoted to IR training)
Please describe your involvement with teaching medical students, residents and fellows in Interventional Radiology. Of particular interest are your involvement in the program (i.e. fellowship director), number of residents, number of fellows and teaching time commitment. 

If you are applying under Criteria 3:

Please describe your involvement in the Society of Interventional Radiology and/or your service to the field of vascular and interventional radiology. In particular, please specifically describe your SIR committee involvement, volunteer involvement at the annual meeting (workshops, plenary session, etc.), and your local/regional involvement in advancing the field of interventional radiology.


Click here to review more information about the criteria and requested supported documentation.    



CURRICULUM VITAE

BOARD CERTIFICATION

Signature