Your responses to questions marked with * are VOLUNTARY, will be kept confidential,
and will not be used to deny access or admission. The information will, however,
assist the University in providing data to demonstrate compliance with federal regulations.
If you are not a citizen, please answer the following questions regarding immigrant
status and visa type.
Please list the names of three members of the medical faculty whom you have requested
to send reference letters. One should be the chair of the Department of Medicine
or the director of the residency program.
(ALL FILES MUST BE FILE TYPES .DOC, .DOCX, OR .PDF)
Please upload the following supporting documents that need to accompany your application.
Personal Statement Guidelines: Be sure to include your rational for pursuing the fellowship as well as a description of your future career goals.
Scanned copies of your Step 1, 2, and 3 USMLE score reports:
NOTE: To complete your application, please direct your letter writers to send
their letters of recommendation to the address below. Three letters of recommendation (one of
which must be from your department chair or program director) are required.
General Internal Medicine
Fellowship Training Program
ATTN: Annette Sampson
University of Pittsburgh
General Internal Medicine Fellowship Coordinator
Department of Medicine, Office of Education
UPMC Montefiore Hospital, N715
200 Lothrop Street, Pittsburgh, PA 15213
Phone: 412-683-7647; Fax: 412-692-4944
If you have waived your right to see your letters of recommendation, please upload a signed
statement on official letterhead indicating this.
Electronic applications do not need to be signed. Checking the box below is considered
equivalent to your signature.
I certify that the information provided on this application form and supporting
documentation is accurate and correct. I understand that providing false and misleading
information is just cause for disqualification for admission or dismissal from the
University of Pittsburgh. If enrolled as a student, I agree to abide by the rules
and regulations set forth by the University of Pittsburgh as they are at the time
of my admission or as they may change during my continuance as a student.
The University of Pittsburgh values equality of opportunity, human dignity, and
racial/ethnic and cultural diversity. Accordingly, the University prohibits and
will not engage in discrimination or harassment on the basis of race, color, religion,
national origin, ancestry, sex, age, marital status, familial status, sexual orientation,
disability, or status as a disabled veteran or a veteran of the Vietnam era.