PRITE Fellowship Nomination

PRITE Fellowship Nomination Form

Fellowship type

Name*: PRITE Fellowship
Child PRITE Fellowship
PRITE w/CHILD PRITE Consideration

Nominee

Name*
Degree(s)*
PGY*
Date Residency Began*

Nominee Institution

Facility*
University*

Address*

City, State, Zip*
Country*
Work Phone*

Nominee Residence

Address*

City, State, Zip*
Country*
Home Phone*
Mobile Phone*
Email*

Nominator

Name*
Degree(s)*
Title*
Work Phone*
Email*

Questions

: Reasons why this fellowship would be a good fit for the candidate career goals.*

: The American College of Psychiatrists is committed to diversity, respectful inclusion, and equity. With this in mind, please explain (if known) how the candidate would promote these values and add to the richness of the experience.*

: Please address how this activity will be made a part of the expected residency activities/standard workday so that the candidate is supported timewise and through mentoring.*

Please answer/elaborate on the following items related to the candidate: *

Ability to work in teams;
Open-mindedness;
Academic/scholarly activity track record;
Lifelong learner (in practice and mindset);
Believes in continuous improvement

Required documents

: PDFs only
Candidate Letter*
CV/Resume*
Sample Questions*: Please remove all identifying information (questions are scored blindly)
Candidate Question Sign off*: Download document to be signed by Nominee
CHILD PRITE PD Sign-off Letter: Only if Adult Psychiatry Program Director wishes to nominate a current PGY 3 resident for CHILD PRITE (should include a brief statement of support from the Child Fellowship Director).

NOTE: Each separately accredited sponsoring institution may submit only one nomination.

NOTE: Candidates may be nominated for either the PRITE or Laughlin Fellowship, not both in the same year. Those selected as a PRITE or Laughlin Fellow may not apply for the other fellowship in future years.

DEADLINE: Applications due by: May 15th of each calendar year