NASBS

North American Skull Base Society

NASBS Neurosurgery Skull Base Fellowship – Match Withdrawal Request

Match Withdrawal

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 match withdrawal for applicants who are not able to honor the binding commitment. Applicants who wish to withdraw from the NASBS Match must submit the following form to be reviewed by the NASBS Match Committee. The decision to grant or deny the match withdrawal is at the sole discretion of the NASBS Match Committee. To request a match withdrawal, complete this form in its entirety and submit prior to the rank order list submission deadline. The request will be sent to [email protected]. Failure to provide all of the information requested will delay the processing of your request. In addition to submitting this form, DO NOT submit a rank order list.

Applicant Information

Name(Required)

Additional Information

Reason for Match Withdrawal 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.

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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