NASBS Neurosurgery Skull Base Fellowship - Match Withdrawal Request

The NASBS Match requires both programs and applicants to honor the binding commitment of the match process. If a match occurs, the applicant must accept the fellowship position, and the program must accept the applicant. Additionally, applicants are expected to begin their fellowship in good faith—meaning with the intent to commence and complete the program—on the start date specified by the fellowship site.

In limited circumstances, the NASBS Match may grant a withdrawal for parties who are unable to honor this commitment. Applicants or programs seeking to withdraw from the NASBS Match must submit a Match Withdrawal Request Form for review by the NASBS Match Committee. Approval or denial of any withdrawal request is at the sole discretion of the NASBS Match Committee. If you are requesting a withdrawal, do not submit a rank order list.

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Applicant Information/Program Information

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Fellowship Program Name

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Additional Information

Reason for Match Withdrawal Request (please choose only one option):(Required)

Unanticipated Serious or Extreme Hardship (e.g. change in personal circumstances, financial hardship)

Credentialing Issue (e.g. unable to obtain state medical license)

Visa Issue (e.g. unable to obtain US/Canadian Visa)

Change in Surgical Specialty (e.g. no longer pursuing Skull Base training)

Please provide additional information below:

The NASBS Match Committee will review this request and will be responsible for determining if a violation to the NASBS Match Bylaws has occurred. If so, appropriate action for the violation may be taken. Please provide as much additional information as possible and include timelines where possible.

Form Submission

By submitting this form, I acknowledge and represent that the information contained in this form is true and correct. I understand and accept that I may be contacted by the NASBS Match office and/or Committee for additional information. I understand and accept that the information contained in this form will be circulated to the NASBS Match Committee for review and that all match withdrawals must be approved by the NASBS Match Committee.

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NASBS Neurosurgery Skull Base Fellowship – Match Withdrawal Request

Applicant Information/Program Information

Additional Information

Form Submission