Obesity Medicine Clinical Fellowship Application

The clinical fellowship in obesity medicine hosted by NYU Langone’s Comprehensive Program on Obesity is accepting applications for a position starting in July 2022.

The deadline to submit your materials is December 3, 2021. Applicants should email their materials to obesitymedicinefellowship@nyulangone.org.

* indicates required field.

Personal Information

Full Name

Current Mailing Address

Address

Address 2

City/Town

State/Province

Zip/Postal Code

Country

Permanent Address

Address

Address 2

City/Town

State/Province

Zip/Postal Code

Country

Phone

Email Address

Citizenship Information

Are you a U.S. citizen?

If you are a U.S. citizen, are you a citizen of any country in addition to the United States?

If you are a dual citizen, list the country of citizenship other than the United States.

If you are not a U.S. citizen, list citizenship status.

Please note that J-1 visas are offered only through the Educational Commission for Foreign Medical Graduates^® (ECFMG^®) to candidates in need of sponsorship.

Military Information

Are you committed to fulfill a U.S. military active duty service obligation or deferment?

If yes, for how many more years, and in what branch of the military?

Do you have any other service obligations, such as Military Reserves, public health/state programs, etc.)?

If you do have other service obligations, please describe them in 50 words or less.

Biographical Information

Gender

Birthplace

Birth Date

Self Identification

This section allows you to indicate how you self-identify. If you prefer not to self-identify you can skip this section.

How do you identify yourself? Please select all that apply.

What languages do you speak? List all that apply.

For each language you list, including English, please rate your proficiency using the following guidelines:

Native/Functionally: I converse easily and accurately in all types of situations. Native speakers, including the highly educated, may think that I am a native speaker, too.

Advanced: I speak very accurately, and I understand other speakers very accurately. Native speakers have no problem understanding me, but they probably perceive that I am not a native speaker.

Good: I speak well enough to participate in most conversations. Native speakers notice some errors in my speech or understanding, but my errors rarely cause misunderstanding. I have difficulty communicating about healthcare concepts.

Basic: I speak the language imperfectly and only to a limited degree and in limited situations. I have difficulty in or understanding extended conversations. I am unable to understand or communicate most healthcare concepts.

Licensure

Please enter information for each of your state medical licenses. Include the state issued, license type, license number, and expiration date.

Additional Information

Was your medical education/training extended or interrupted?

If yes, please provide details.

Has your medical license ever been suspended/revoked/voluntarily terminated?

If yes, please explain.

Have you been named in a malpractice case?

If yes, please explain.

Is there anything in your past history that would limit your ability to be licensed or would limit your ability to receive hospital privileges?

If yes, please explain.

Have you ever been convicted of a misdemeanor in the United States?

If yes, please explain.

Have you ever been convicted of a felony in the United States?

If yes, please explain.

Are you able to carry out the responsibilities of a fellow in the specialty, and at NYU Langone’s Obesity Medicine Clinical Fellowship program to which you are applying, including the functional requirements, cognitive requirements, and interpersonal and communication requirements with or without reasonable accommodations?

If no, please list your limiting aspect(s).

Are you board-certified?

If yes, what is the name of the board?

DEA Registration Number

Personal Statement

Describe your individual experiences and unique interest in the field of medical obesity, including how you plan to contribute to further advances in the field. Please limit your statement to 500 to 750 words.

I certify that the information contained within this application is complete and accurate to the best of my knowledge. I understand that any false or missing information may disqualify me from consideration for this position; may result in an investigation by the academic institution as well as the Association of American Medical Colleges; may also constitute cause for termination from this program.

First and Last Name

Date

Supporting Documents

In addition to this online application, please submit the following documents via email or mail:

CV with accurate publication citations, including peer-reviewed articles and articles currently under review, oral and poster presentations, and any other relevant publications
contact information for three references, one of whom must be a current program director or supervisor
valid Educational Commission for Foreign Medical Graduates^® (ECFMG^®)certificate, if your medical school is outside the United States

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Obesity Medicine Clinical Fellowship Application | NYU Langone Health

Obesity Medicine Clinical Fellowship Application

Personal Information

Citizenship Information

Military Information

Biographical Information

Self Identification

Licensure

Additional Information

Personal Statement

Supporting Documents