Application form

University of Michigan, Radiation Oncology Physics Residency Application Form

University of Michigan

Department of Radiation Oncology

Division of Radiation Physics

1500 E. Medical Center Dr.

Room B2C438, SPC 5010

Ann Arbor, Michigan 48109-5010

Radiation Oncology Physics Residency Application Form

PERSONAL INFORMATION

Name: _____________________________________________________________________________

Last First Middle

Address: ___________________________________________________________________________

Street

___________________________________________________________________________________

City State Country Zip Code

Telephone Number: __________________________________________ (home/work)

__________________________________________ (cell)

E-mail Address: ______________________________________________________________________

Citizenship: _________________________________________________________________________

If you are not a U.S. citizen, are you currently eligible to work in the U.S.A.? ____ Yes _____ No

If yes, what is your Visa type? ___________________________________________________ or what is your immigration status? _________________________________________

EDUCATIONAL INFORMATION

Was your undergraduate major physics? ____ Yes ____ No

If no, please complete items 1 -7 below to indicate that you have earned the equivalent of a minor in physics. Candidates are required to submit official copies of transcripts from all institutions in which these requirements were satisfied.

1.

Calculus based general physics I

Equivalent course name:______________________________________________________________

Course Number:________________________________ Semester & Year Taken:________________

Institution Course Taken:_____________________________________________________________

Grade:_________________

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2.

Calculus based general physics II




Grade:_________________

3.

Electricity and Magnetism




Grade:_________________

4.

Atomic Physics




Grade:_________________

5.

Nuclear Physics




Grade:_________________

6.

Modern Physics




Grade:_________________

7.

Quantum Mechanics or Mechanics




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Grade:_________________

What will your highest graduate degree be at the start date of this position?

____ M.S. ____ Ph.D. ____ DMP

Are you a graduate or do you anticipate graduating from a CAMPEP-accredited graduate program before the start date of this position? ___ Yes ___ No

Please complete items 1 -6 to confirm that you have satisfied the minimum didactic requirements per AAPM Report #197. Only candidates that have successfully completed four of these six courses

will be considered as an eligible candidate. In addition to undergraduate and graduate transcripts, candidates are required to submit official copies of transcripts from all institutions in which these requirements were satisfied.

1.

Radiological physics and dosimetry




Grade:_________________

2.

Radiation protection and radiation safety




Grade:_________________

3.

Fundamentals of Imaging in Medicine




Grade:_________________

4.

Radiobiology




Grade:_________________

5.

Anatomy and Physiology

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Grade:_________________

6.

Radiation Therapy Physics




Grade:_________________

ABR Status:

____ Have not applied

____ Applied but have not received word concerning approval to take exam

____ Approved to take Part 1

____ Passed Part I; Date:_______________________

____ Passed Part II; Date:_______________________

____ ABR Certified; Date:_______________________

REFERENCES:

Candidates are responsible for contacting each of their references to request that they submit a letter of reference to the residency committee at the University of Michigan. References may send an electronic copy of their letter to the residency committee.

1.

Name: ________________________________________________________

Institution/Position:______________________________________________

E-mail:_________________________________________________________

Phone Number: _________________________________________________

2.

Name: ________________________________________________________


E-mail:_________________________________________________________

Phone Number: _________________________________________________

3.

Name: ________________________________________________________

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E-mail:_________________________________________________________

Phone Number: _________________________________________________

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All applicants must submit the following information along with a brief cover letter to be considered for this position. Electronic submissions are preferred. It is the applicant’s responsible to ensure that all of the material is received in a timely manner. All materials must be received by the application deadline.

Any incomplete applications will not be considered for this position.

1.

2.

3.

4.

5.

Application form

Curriculum vitae – This document should detail, but not be limited to, the applicant’s education, dissertation title/topic, teaching experience, research experience, publications, presentations, special training, and academic awards.

Statement of interest - Applicant’s are required to summarize their interests and goals, and include a statement describing how they learned and/or why they are interested in radiation

oncology physics. Applicant’s who are not currently in the field of medical physics should describe how their background and knowledge can contribute to the field. Document should be limited to no more than two, double-spaced pages of text.

Official transcripts - Applicant’s must submit an official copy of their undergraduate and graduate transcripts c/o Joann Prisciandaro, to the address listed above. For non-English transcripts, a certified or notarized English translation of the document is required. Candidates must demonstrate they have completed the minimum number of undergraduate and graduate didactic prerequisites, as defined by the ABR and CAMPEP.

Letters of reference - Applicant’s should request three letters of reference from individuals that can attest to the applicant’s qualifications, and are familiar with their academic and/or clinical background. The letter should state how long the individual has known the applicant, and in what context. The letter should concentrate on the applicant’s character, aptitude, skills, and attributes, such as intelligence, ability to communicate, self-confidence, initiative, interpersonal skills, and direction. The letters MUST be submitted directly from the reference either electronically or through the mail, or mailed in a sealed envelope with the candidate’s application package.

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