Request for Training Extension

Program contact name *

Program contact email *

Department name *

Program name *

Resident/Fellow name *

Reason for training extension *

e.g. Parental leave

If the extension is a result of taking a leave of absence, please ensure the impacts of the extension have been discussed. For more information, visit our Leave resources, here.

Current appointment end date *

As listed in MedHub.

Extension end date *

Current R Level *

As listed in MedHub.

FTE needed for extension (list all applicable hospitals) *

Please list amount of additional FTE needed per hospital (Guideline: One month = 0.08 FTE)

Will the program need a complement increase? *

A temporary complement increase is required in circumstances where the total number of trainees exceeds the approved ACGME complement.

Any additional information to share with GME

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Hadar Duman, MHI - Headshot

Hadar Duman, MHI

Director of Accreditation
Phone: 206.616.2961
Email: hadars@uw.edu

Shinetra Pryor

Appointment Manager
Phone: 206.221.1452
Email: snpryor@uw.edu

Extensions Quick Links

Procedure for Submitting Extension of Training Requests

RFPA Amendment to Extend Current Appointment

GME Process for ACGME Trainee Complement Increase

Quick Links

ACGME

MedHub

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