Application Form

If no, please complete the New Center Survey

Please upload your Human Subject Protection training document (required)

Please upload your Good Clinical Practice training document (required)

Please select your Full Membership rolePhysicianNurse PractitionerPhysician Assistant

1. Your pediatric rheumatology fellowship (for those performing fellowship out side of Canada or US or in adult rheumatology, please see PRCSG bylaws for required additional information).

2. Your involvement in the treatment of children with pediatric rheumatic diseases (e.g. number of days in pediatric rheumatology clinic per week) and approximate number of pediatric rheumatology patients or visits per month or year.

3. Your pediatric hospital including availability of other pediatric subspecialities such as ophthalmology, ICU, etc.

For Nurse Practitioner and Physician Assistant applicants, please provide the following documents:

• Letter of support from a PRCSG member confirming your active involvement in clinical practice or clinical research that has an element related to pediatric rheumatology.

• Letter of support from a PRCSG member physician working in the same location confirming adequate training in the field of pediatric rheumatology.

Please select your Associate Member rolePediatric Rheumatology TraineeResearch Nurse and Other Research Professionals

Pediatric Rheumatology Trainee
Please provide the following document:

• Letter of support from fellowship program director confirming you are currently in a pediatric rheumatology fellowship program or are currently in a pediatric rheumatology fellowship program or in a combined adult and pediatric rheumatology fellowship program.

Research Nurse and Other Research Professionals (Bachelor’s degree or higher in a research-related field)
Please provide the following document:

• Letter of support from a Full PRCSG member confirming active involvement in clinical research and adequate experience that is related to pediatric rheumatology.