Form Confirming Reading and Understanding the fellowship information on the University of Colorado Denver Department of Radiology web site.

I __________________________________ have read and understand and will do my best to abide by the guidelines setforth in, and meet the requirements of the following sections on the UCD Neuroradiology Web Site pertaining to my Neuroradiology fellowship. I also understand that these pages may be periodically updated and it is my responsibility to check this site regularly for updates.

Fellow Responsibilities (http://www.uchsc.edu/neuroimaging/fel_resp.htm)

Fellow Goals (http://www.uchsc.edu/neuroimaging/fel_goal.htm)

ACGME Neuroradiology Fellowship Guidelines (http://www.uchsc.edu/neuroimaging/fel_agme_requirements_jan2002.pdf)

Evaluation / Competencies (http://www.uchsc.edu/neuroimaging/fel_eval.htm)

_______________________________________
(fellow signature and date)

_______________________________________
(program director signature and date)

_______________________________________
(fellowship year)

Please print this form, complete and return to Dr. Escott.