1. New Program Request (insert Program Name)

2. (insert Program Name) (ACGME or non-ACGME Accredited)
(Rationale: Is there a need nationally or locally? After training, academic or private practice?)
(Explain sufficient patient volume and faculty expertise to create a competitive program)
(How will the program function with core and sub-specialty programs)

3. This program will enhance the institution by:
The goals and objectives are (list):

4. Applicants…..
(How many are expected and how many per year).

5. Letters of Support……
(from Program Director/s who will likely be impacted and core program)

6. (Briefly describe specific provisions (funding) to insure adequacy of the new program. Note: The rationale must be exclusively educational and not based on specialty demands)

7. Thank you for your consideration.