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Apply to the Department of Surgery

Applicants can submit this application electronically or print and return by mail to:

Pamela A. Lipsett, M.D. Professor
Departments of Surgery and Anesthesiology/Critical Care Medicine and Nursing
Co-Director, Surgical Intensive Care Unit
Director, Surgical Critical Care Fellowship

Johns Hopkins Medical Institutions
Blalock 685
600 North Wolfe Street
Baltimore, Maryland 21287-4685

All applicants who are granted interviews will be required to sign their electronically submitted application form to confirm that the above answers are true and complete to the best of their knowledge.

Date You Desire To Start Fellowship «

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Date of Birth «

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Institution 1 «

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Institution 2

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Professional Education

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Internship, Residency, Fellowship and Other Graduate Training

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Degree(s)

Licensure

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Dates

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National Board of Medical Examiners Diploma

Yes No

ECFMG Certificate

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