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Residency Letter of Intent: Template, Examples and Each Specialty's Rules
When to send a residency letter of intent or interest, what 13 specialties' 2026-27 program director guides say, a fill-in template, examples, the NRMP rules, and thank-you notes.
A residency letter of intent tells one program it is your first choice and that you will rank it first. Send it only if that is true, to one program, and only where post-interview letters are welcome: dermatology and plastic surgery say not to send them. Make it a short email to the program director before ranking. It binds no one and rarely changes how you are ranked.
Should you send one?
- The program or specialty says no: don't. The AAMC warns that ignoring a program's instructions can hurt you.
- You are sure of your first choice: send a letter of intent to that one program after your last interview and before the rank list deadline.
- You are not sure: send nothing, or a letter of interest that says the program is one of your top choices.
What each specialty says for 2026-27
From each specialty's program director guide for this season:
Internal medicine: No thank-you notes, questions welcome
“Programs should articulate that interviewees refrain from sending “thank you” notes.”
Internal medicine guide, 2026-27 · Internal medicine interview questions
Dermatology: No letters of intent or thank-you letters
“These types of communication are typically not used by residency programs in decision-making and lead to downstream pressures on applicants.”
Dermatology guide, 2026-27 · Dermatology interview questions
Plastic surgery (integrated): No post-interview letters (ACEPS policy)
“Applicants who are interested in a program may find better results by asking a trusted mentor to reach out on their behalf.”
Pediatrics: Letter of intent to one program at most
“Letters of intent are not expected and, if sent, should only be sent to one program.”
Family medicine: Letters of intent discouraged, thank-you notes welcome
“Applicants are discouraged from sending letters of interest or intent to rank.”
Family medicine guide, 2026-27 · Family medicine interview questions
Anesthesiology: Welcome, not used in ranking
“If an applicant would like to send a thank you note or a letter of interest, they are welcome to do so.”
Anesthesiology guide, 2026-27 · Anesthesiology interview questions
Psychiatry: A simple thank-you only, nothing more
“No post-communication aside from a simple thank-you is recommended.”
General surgery: Acceptable, not required
“Thank you letters or post-interview communication is acceptable but not required.”
General surgery guide, 2026-27 · General surgery interview questions
Emergency medicine: Not required or suggested
“There is no requirement nor suggestion that post-interview communication be sent to programs.”
Emergency medicine guide, 2026-27 · Emergency medicine interview questions
OB/GYN: Each program decides
“The specialty is asking residency programs to be transparent about the program’s preferences around and use of post-interview communication such as thank you notes and letters of intent.”
Urology: Thank-you notes allowed, programs won't reply
“Applicants may write thank you notes. Programs should not respond to thank you notes.”
Diagnostic radiology: Not required, programs usually say
“Somewhat program specific, but generally post-interview communications are not required. Usually, programs will give guidance.”
Diagnostic radiology guide, 2026-27 · Diagnostic radiology interview questions
Neurology: Not expected
“Applicants are not expected to engage in post-interview communication but may contact programs with specific questions.”
All guides: Program Directors Association Guides for Residency Applicants (2026). A program's own instructions come first.
Letter of intent template
Fill in the fields and copy the email. Nothing you type leaves your browser.
Example email
86 words
Subject: Letter of intent, Riverside Pediatrics
Example: letter of intent, emergency medicine
Dear Dr. Hassan, I am writing to let you know that Bayview Emergency Medicine is my first choice, and I will rank it first. Working a shift with your residents at the county hospital showed me the kind of safety-net care I want to train in, and the ultrasound track fits my plan to teach point-of-care ultrasound. Thank you for your time and for a great interview day. Best, Alex Kim
Example: letter of interest, internal medicine
Dear Dr. Brooks, I am writing to let you know that Lakeside Internal Medicine remains one of my top choices. Since my interview I have had a paper on readmissions accepted, and your quality improvement curriculum is the one I keep coming back to. Thank you for your time and for a great interview day. Best, Sam Ortiz
What not to write
“You are my first choice” to more than one program
The 2027 Match Participation Agreement treats misleading information as a possible violation, and program directors talk to each other. Send a letter of intent to one program, and only if it is true.
A promise you might not keep
If your plans change, rank in your true order anyway. The letter binds no one, but breaking your word to a program you told it was first is a professional risk.
Asking where they will rank you
Applicants may express interest but may not ask a program for a commitment to rank them.
A long letter
A short paragraph with specifics from your interview day beats a page about yourself.
A note to a program that asked for none
Following the program's own instructions is the professional choice, and it never counts against you.
The rules, and whether it helps
What the NRMP allows
The 2027 Match Participation Agreement lets you tell a program you are interested, and lets a program tell you that you will be ranked. Neither side may ask the other for a commitment to rank, and programs may not ask how you will rank them or make your place on their list depend on a letter. Misleading information can count as a violation, and the AAMC notes that violations can bring sanctions, up to a ban from the Match for several years.
Only the rank list you certify decides where you match.
NRMP, 2027 Match Participation Agreement for Applicants, sections 6.3 to 6.5 · AAMC, Letters of Interest
Does a letter change your rank?
Rarely. The AAMC says letters of interest have little to no impact on ranking decisions in most cases. In a 2019 urology survey, 81.7% of program directors said applicants' promises did not influence their rank list. In an otolaryngology study, no program director agreed that declarations of intent affect their list, though 82.8% of applicants sent one to their first choice.
Thank-you notes
Internal medicine's guide asks programs to tell applicants not to send thank-you notes, dermatology's and plastic surgery's say not to, and most others call them optional. Where they are welcome, send a short email right after the interview to each person you met, with one detail from your conversation.
Timing and format
EMRA and CORD's emergency medicine guide says it is best to send it immediately after the interview. In a 2019 survey, 78.2% of emergency medicine program directors preferred email, 22.6% said a thank-you could move an applicant up and 10.8% said down.
Thank-you note: to a faculty interviewer
Dear Dr. Chen, Thank you for talking with me during my interview at Lakeshore Family Medicine. I enjoyed hearing how your clinic runs group prenatal visits. Full-scope care with obstetrics is what I want from training, so it was great to see how residents take part. Thank you again for your time. Best, Sam Ortiz
Thank-you note: to a program director
Dear Dr. Alvarez, Thank you for the time you gave me during my interview at Northfield Anesthesiology. Your point about residents leading the morning safety huddle stayed with me, since speaking up in the operating room is something I care about. Thank you again for a great day. Best, Priya Nair
Thank-you note: to a resident or coordinator
Hi Maria, Thank you for organizing such a smooth interview day and for answering my questions about night float. It helped me picture what the first year looks like. Best, Jordan Lee
Frequently asked questions
What is a letter of intent for residency?
A short email after your interviews that tells one program it is your first choice and that you will rank it first. A letter of interest says a program is one of your top choices without that promise. Neither is required, and neither is binding.
When should I send a residency letter of intent?
After your last interview, once you are sure of your first choice, and before the rank list deadline (March 3, 2027, at 9 p.m. Eastern for the NRMP Main Residency Match). Programs build their lists in the same weeks, so earlier in February is better than the last day.
Can I send a letter of intent to more than one program?
No. A letter of intent says you will rank the program first, so it can only be true for one. Pediatrics' guide asks applicants to send one to one program at most, and the Match Participation Agreement treats misleading information as a possible violation. Send letters of interest to the others if you want to.
Who should I send it to?
The program director, by email, unless the program says otherwise. Some programs ask you to copy the coordinator. If you had a strong connection with one faculty interviewer, a short separate note to them is fine where the program allows it.
Should I send a thank-you email after a residency interview?
Only if the program and its specialty welcome them. Internal medicine, dermatology and plastic surgery guides say not to, and many programs say so in their invitation. Elsewhere it is optional: a short email right after the interview, one per interviewer.