1. The Nomination Form MUST BE TYPED. Handwritten copies are not accepted by the ACR and will be returned to their source.

2. Only current Nomination Forms are acceptable. If a fellow candidate did not receive the form from a representative of the Pennsylvania Radiological Society (PRS), her/she should check with the PRS Office to make sure that he/she is using the current form. The phone number is 717-898-6006.

3. If a fellow candidate does not have a typewriter or would prefer to use his/her computer to complete the form, he/she may access the current version of the form, as follows: a) go to www.acr.org; b) click on the "Members" tab; c) click on "ACR Fellowship Guide"; d) Click on Fellowship Nomination Form." You will need Acrobat Reader to access the form from the website. If you do not have Acrobat Reader, click on "PDF Format" instead of "Fellowship Nomination Form" and you will find downloading instructions. Once Acrobat Reader has been downloaded, click on "Fellowship Nomination Form." Once you complete the form on the computer, YOU MUST PRINT OUT THE COMPLETED FORM FOR SUBMISSION. You cannot submit an electronic version of the form to the PRS or ACR.

4. DO NOT USE "see attached CV" to complete any section of the form. If there is not enough room in a particular section, a separate sheet should be used.

5. Full addresses for both office and residence, along with phone numbers, fax numbers and e-mail address(es) are required.

6. A printed copy of your current Curriculum vitae should be appended to the form.

7. A diskette with an electronic copy of your current curriculum vitae using Microsoft Word should be appended to the form. This must be identical with the printed copy.

8. A minimum of two sponsors must sign and date the Nominating Form in the Endorsement Section. Sponsors must be fellows of the ACR in good standing. One of the sponsors must not be in practice with the candidate. If it is inconvenient for a sponsor to physically sign the form, it is acceptable to fax a copy of the endorsement page to the sponsor, who can then sign the faxed copy and return it by fax to the candidate.

9. Sponsors must also write a letter of recommendation to endorse the candidate. These may be sent to the candidate to append to the form or they may be sent independently to Dr. Love. Nominees may solicit more than the minimum two required letters.

10. Completed Nomination Forms with all necessary attachments must be submitted to: Michael B. Love, M.D, Chair, PRS Committee on Fellowship, 205 E. Fiedler Road, Ambler, PA 19002

11. The deadline for receipt of completed Nomination Forms is SEPTEMBER 15 of each year. Candidates are urged to submit in advance of this date so that there is time to correct any errors or omissions prior to the deadline.

DEADLINES ARE STRICT. FORMS RECEIVED AFTER THE DEADLINE WILL NOT BE CONSIDERED UNTIL THE FOLLOWING YEAR. FORMS WITH SIGNIFICANT ERRORS OR OMISSIONS WILL BE RETURNED TO THEIR SOURCE FOR REVISION.

Michael B. Love, M.D., FACR
Chairperson, Committee on Fellowship
Albert Einstein Medical Center
5501 Old York Rd
Philadelphia, PA 19141
phone: 215.456.3438
fax: 215.456.6227