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President Douglas P Zipes, MD . President-Elect W. Bruce Fye, MD, MA Immediate Past President George A. Beller, MD Vice President Carl J. Pepine, MD Secretary Bruce D. Lindsay, MD Treasurer Michael J. Wolk, MD Chair, Board of Governors Bruce D. Lindsay, MD Trustees Morton F. Arnsdorf, MD George A. Beller, MD Robert O. Bonow, MD Ralph G. Brindis, MD, MPH Robert M. Califf, MD Melvin D. Cheitlin, MD Michael H. Crawford, MD Pamela S. Douglas, MD James T. Dove, MD, ex officio Kim A. Eagle, MD Bernard W. D. Fong, MD W. Bruce Fye, MD, MA Arthur Garson, Jr., MD, MPH Raymond J. Gibbons, MD John W. Hirshfeld, Jr., MD Robert H. Jones, MD, ex officio Spencer B. King, III, MD Costas T. Lambrew, MD Marian C. Limacher, MD Bruce D. Lindsay, MD Ben D. McCallister, MD Joseph V. Messer, MD Gerald V. Naccarelli, MD Carl J. Pepine, MD George W. Vetrovec, MD L. Samuel Wann, MD W. Douglas Weaver, MD William S. Weintraub, MD Roberta G. Williams, MD Michael J. Wolk, MD Douglas P. Zipes, MD Chief Executive Officer Christine W. McEntee
MEMO TO:
PRECEPTORS for Applicants for the 2003-2004 ACC/Merck Adult Cardiology Research Fellowship Awards Program ACC/Merck Fellowship Awards/ International Exchange Committee
FROM:
The ACC/Merck Fellowship Awards/International Exchange Committee requires that Preceptors and any other investigators who will supervise or support the applicant complete the enclosed “Biographical Sketch” form and return it with the application. The “Biographical Sketch” should not exceed 3 pages (this can be substituted with your current NIH biosketch). In addition, the preceptor’s letter of recommendation should include a detailed description of the training program and the facilities and resources available, and should state the number and nature of trainees in the laboratory or program. If the preceptor is also the training director, a second letter of recommendation is required from another faculty member.
The mission of the American College of Cardiology is to foster optimal cardiovascular care and disease prevention through professional education, promotion of research, leadership in the development of standards and guidelines and the formulation of health care policy.
PRINCIPAL INVESTIGATOR/PROGRAM DIRECTOR: _____________________________________________________________________________
PRECEPTOR'S BIOGRAPHICAL SKETCH
NOTE: Can Substitute your most recent or modified NIH Biosketch
NAME
POSITION TITLE
BIRTHDATE (Mo,Day,Yr)
EDUCATION (Begin with baccalaureate or other initial professional education, such as nursing, and include postdoctoral training)
INSTITUTION AND LOCATION
DEGREE
YEAR CONFERRED
FIELD OF STUDY
RESEARCH AND PROFESSIONAL EXPERIENCE: Concluding with present position, list, in chronological order, previous employment, experience and honors. List, in chronological order, the titles and complete references to all publications during the past three years and to representative earlier publications pertinent to this application. DO NOT EXCEED TWO PAGES.