Information for the APM Directory of U.S. C-L/PM Fellowship Training
Programs
1. Fill in all information requested. Fields will expand as you type; the tab key moves
forward through the fields; shift+tab moves backwards.
2. “Save As” the document to your hard drive, giving it a filename that includes a hint
of your institution name (e.g., “fellowship-form-UFlorida.docx”).
3. E-mail the document to webmaster@apm.org with CC to apm@apm.org.
For examples of what others have submitted, see: http://www.apm.org/cl-pgms/
Contact Name (usually the Director):
Contact’s Title:
Division/Department (optional):
Institution Name:
Street Address:
City/State/Zip:
Phone:
E-mail:
Is the fellowship program ACGME-approved?
Yes
No
Does your program accept the Common Application for PM Fellowship?
Yes
No
Number of available positions:
as of:
(month/year)
Duration:
year(s)
# Hospital Beds:
# Inpatient Consults:
per year
Full Time/Part Time:
FT
PT
# Full-time Faculty Equivalents:
Annual Salary: $
Funding:
% funding fees
% government
% hospital
% medical school
% private grants
Instructor-level Faculty Appointment?
Yes
No
Clinical Experience:
Hours:
# New Cases:
# Follow-up Cases:
Supervision:
Conferences, Rounds, Seminars:
hours/week
per week
per week
hours/week
hours/week
Teaching Experience:
Medical Student:
Psychiatry Resident:
Liaison:
hours/week
hours/week
hours/week
Form version 7/28/2014
Research Experience:
Required?
Yes
[optional:
Academic Project Required?
Yes
No
hours/week]
No
Comments: (less than 100 words)
On the Web? If you have a web page that contains more information about your fellowship,
please enter the URL (web address) of the page:
Form version 7/28/2014