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ALTERNATE ENTRY PATH PROGRAM APPLICATION
Research & Fellowship Pathway

  1. Complete the form below and upload the supporting documents.

  2. Mail the $2,500 check for the application fee to:
    ABA Secretary
    The American Board of Anesthesiology
    4208 Six Forks Road, Suite 1500
    Raleigh, NC 27609-5765

  3. Download, print and complete this mail-in form to send with your check.

 

Program Information

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Physician Applicant Information

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Gender*
Birth Date*
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Address of Foreign Certifying Board*
 
City* State*
 
Postal Code* Country*
Date Certification Awarded*
Date applicant will enroll in your program*

UPLOAD THE FOLLOWING DOCUMENTS

Applicant’s Curriculum Vitae*
Upload cover letter (on institutional letterhead), signed and dated, by the chair of the anesthesiology department that sponsors the internationally trained and certified anesthesiologist.*
Detailed plan of the applicant’s four-year experience*
Documentation of the applicant’s anesthesiology certification in a foreign country*
Documentation of the physician’s medical or osteopathic degree*
Documentation of the physician’s anesthesia postgraduate training - Must be comparable in duration to U.S.ACGME-accredited anesthesiology programs*

Upload evidence of one of the following:

  • a permanent (valid indefinitely) certificate from the Educational Commission for Foreign Medical Graduates

  • comparable credentials from the Medical Council of Canada

  • an active license to practice medicine or osteopathy in one state of the U.S. or in Canada that is permanent, unconditional and unrestricted
Applicant's certificate, credentials or license*
Evidence of scholarship of discovery, dissemination and application*
Please select the experience planned for the applicant. All must be completed at an ACGME-accredited training program *
Start date for the experience you selected above.*
End date for the experience you selected above.*