ATC Program Description Update Form

Please use the form below to update your program description as it appears on the AHNS website.

To review your current description, visit the Directory of Accredited AHNS Fellowships – in updating your description, you do NOT have to complete the entire form below – inly the sections you have updates for:

NAME OF PROGRAM(Required)

Program Director Name:

First Middle Last Degrees

Program Director Institutional Title:

Program Director Email:

Program Director Phone:

Program Co-Director Name:

First Middle Last Degrees

Program Co-Director Institutional Title:

Program Co-Director Email:

Program Co-Director Phone:

Program Coordinator:

First Last

Program Coordinator Email:

Program Coordinator Phone:

Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Website:

Department Chair:

First Middle Last Degree

Faculty Involved with the Fellowship:

Total Number of Positions Available per Year:

Duration

Position Type

i.e. 1 yr Clinical, 1 yr Research

PROGRAM DESCRIPTION

Overview:

Objectives:

Strengths:

Eligibility:

Duties and Responsibilities of Fellows:

Research Opportunities:

Supervision, Teaching and Call:

Past Fellows:

PROGRAM DESCRIPTION

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