Fellowship of the American Society of Neuroimaging (FASN)

Fellowship of the American Society of Neuroimaging (FASN) is meant to recognize individuals who have made significant contributions to the field of neuroimaging and have impacted the growth and practice of neuroimaging at a regional and national level.

First Name: *

Last Name: *

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I attest that I have been a member of ASN the past five consecutive years:

Yes

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I attest that I have attended at least three ASN Annual Meetings:

Yes

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Upload current healthcare license.

If you are a physician please upload documentation of Board Certification.

I attest that I have been in full medical practice (out of training) for at least 5 years.

Yes

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Upload your certifcates in Neuroimaging or Neurosonolgy.

Briefly describe how you have demonstrated a collaborative model of neuroimaging, in which efforts of several disciplines are coordinated to provide optimal patient care.
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Please list your contributions to the perception, delivery, or independent interpretation of imaging in neurosciences, in the areas of Program Development, Scholarly Contributions and Leadership:

Program Development will consist of: 1. Clinical and administrative development with strategies to support independent interpretation of neuroimaging by neurologists, neurosurgeons, emergency or critical care physicians, which should be linked to neuroimaging billing, 2. Academic development with creation/sustaining of a fellowship/clerkship in the neuroimaging, lecture series on neuroimaging, or application of mandatory/elective rotations in neuroimaging from other fellowships/residencies, OR 3. Research development with funded research in neuroimaging.
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Scholarly Contributions will consist of at least five publications in PubMed, applicant may be an author of any rank with main topic being neuroimaging.
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Leadership will be substantiated by individuals who participated as teaching faculty to at least two ASN Annual Meetings, hold the position of Chief of Division or Chair of Department, hold the position of Director of a seminar or lecture series dedicated to neuroimaging at their own institution, or Program Director of UCNS-accredited fellowship program in neuroimaging.
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Be sponsored by two individuals, at least one of whom is an active FASN OR a member of the ASN Board of Directors, who can substantiate the professional history and outstanding merit of the applicant, with particular emphasis on areas of demonstrated excellence and leadership in a collaborative model of neuroimaging.

Sponsor 1:

Name

ASN Leadership Role

Sponsor 2:

Name

ASN Leadership Role

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