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The key to an effective letter of intent is specificity and clarity, particularly for students or IMGs who interviewed positively. It should not be a generic letter sent to all programs but rather tailored to each program, concise, and direct. Address it to the program leader, typically the program director, unless instructed otherwise. A helpful resource for crafting this letter is available for free on my blog, which includes a template and examples. Visit drninalum.com to explore this resource and enhance your letter of intent.