Public Psychiatry Fellowship 
Application Form

Please send your CV with this completed application form by e-mail attachment to Stephanie Le Melle MD at Stephanie.Lemelle@nyspi.columbia.edu  If you have any questions, you can telephone Dr. Le Melle  at 646-774-6322.

Name 

e-mail address 

Residency 

Graduation Year 

Current Position 

Do you have an unrestricted New York State Medical License? Yes,No

If No, please elaborate (e.g. have not completed Step III; not an American Citizen or Green Card Holder) 

Essay: Please address the following questions:   (1) Why do you want to take the Public Psychiatry Fellowship? (2) What experiences have you had in the public sector? (3) What are your career plans for the next five years?