SNMMI Application
2017-2019 Internship Program
Please submit the following to SNMMI by December 9, 2016 at 5:00pm (EST):
q Completed Application
q Copy of current Curriculum Vitae
q Brief Narrative Statement (maximum of 500 words), answering the following question:
What are your future professional goals and how do think the Internship Program will help you move forward in pursuit of obtaining these goals?
Please select the Council/Center in which you would like to serve:
(You may select a maximum of 3; if you select more than one please rank them 1 – first choice)
____ Academic Council ____ General Clinical Nuclear Medicine Council
____ Advanced Associate Council ____ Pediatric Imaging Council
____ Brain Imaging Council ____ Radiopharmaceutical Sciences Council
____ Cardiovascular Council ____ Center for Molecular Imaging Innovation & Translation
____ Computer & Instrumentation Council ____ PET Center of Excellence
____ Correlative Imaging Council ____ Therapy Center of Excellence
____ Clinical Trials Network (CTN)
Personal Information: SNMMI Member #: ______(not required)
______
Last Name First Name Middle Initial Designation
______
Home Address Telephone #
______
City State Zip
______
E-Mail Address
References: Please list two references (Employment, Academic, Other).
______
Full Name E-Mail Phone #
______
Full Name E-Mail Phone #
Certification of Application:
The information contained in this application and the attached curriculum vitae is current and accurate to the best of my knowledge. If I am chosen as an intern, I am willing and able to participate in the two-year program. I certify that I am a young professional (physician, technologist, or scientist) in training or in practice within 10 years of graduation.
______
Signature Date
Please submit all documentation via email, fax or mail to:
SNMMI Internship Program c/o Ana Hilton 1850 Samuel Morse Drive, Reston, VA 20190
Phone: (703) 652-6794 Email: Fax: (703) 708-9020