Fellowship program director reference form for Junior scientist membership applicants All fields are required Please enter the Sponsor's information: Please indicate the name of the person applying for membership: is applying for Junior Scientist membership status in the Society of NeuroInterventional Surgery and has listed you as a Training Program Director Reference. Junior Scientist Members in the Society of NeuroInterventional Surgery are required to: • Be in training in any field of science or engineering with a focus on, and actively performing research in, or directly related to, neurointerventional surgery; • Have a letter of reference from their Training Program Director. Training Program Director Questionnaire: 1. How long have you known the applicant? 2. Is the applicant a current neurointerventional research student or fellow under your direction? 3. Is the applicant actively performing research in neurointerventional surgery under your direction? Do you feel that the applicant is AcceptableUnacceptable as a Junior Scientist Member of SNIS?