Fellowship program director reference form for Junior membership applicants

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    Please enter the Sponsor's information:






    Please indicate the name of the person applying for membership:

    is applying for Junior membership status in the Society of NeuroInterventional Surgery and has listed you as a Neurointerventional Fellowship Program Director Reference.

    Junior Members in the Society of NeuroInterventional Surgery are required to:

    • Be in training in an interventional neuroradiology, endovascular neurosurgery or interventional neurology program;

    • Have a letter of reference from their Program Director.

    Neurointerventional fellowship program questionnaire:

    1. How long have you known the applicant?

    2. Is the applicant a current neurointerventional fellow under your direction?

    3. Approximately how many neurointerventional procedures are performed per year at the institution(s) where the applicant was training?
    <5050-100100-150150-200>200

    Do you feel that the applicant is: AcceptableUnacceptable as a Junior Member of SNIS?