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NASBS

North American Skull Base Society

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NASBS Neurosurgery Skull Base Fellowship – Matching Process Commitment Dissolution

Matching Process Commitment Dissolution

The NASBS Match requires matching process applicants to accept a fellowship position if a match occurs. Additionally, the NASBS Match requires the applicant to start their fellowship in good faith (e.g. with the intent to complete the fellowship program) on the date specified by the program. In limited circumstances, the NASBS Match may grant a matching process commitment dissolution for programs and matched applicants who are not able to honor the binding commitment. Matched applicants and programs are not authorized to release each other from the binding matching process commitment. If a match occurs, an applicant cannot apply for, discuss, interview for, or accept an alternate position. Likewise, if a match occurs, a program cannot offer the position to a different candidate or applicant. An applicant or program wishing to withdraw from the match, must submit the following form to be reviewed by the NASBS Match Committee. The decision to grant or deny the matching process commitment dissolution is at the sole discretion of the NASBS Match Committee. To request a matching process commitment dissolution, complete this form in its entirety. It will be sent to [email protected]. Failure to provide all of the information requested will delay the processing of your request.

Are you an Applicant or a Program?

Applicant Information

Name(Required)

Program Information

Program Director's Name(Required)

Additional Information

Reason for Matching Process Commitment Dissolution request (please choose only one option)(Required)
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.
Have you notified your matched program(s) of your request?(Required)
Have you notified your matched applicant(s) of your request?(Required)

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 and that the NASBS Match office or Committee will also contact the applicant or program for information on all requests for a matching process commitment dissolution. I understand and accept that the information contained in this form will be circulated to the NASBS Match Committee for review and that all matching process commitment dissolutions must be approved by the NASBS Match Committee.
Please type your name here as your signature:(Required)
MM slash DD slash YYYY
This field is for validation purposes and should be left unchanged.

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