AAP Section on Orthopaedics | Global Outreach Scholarship Application
The application period is October 15 through November 30 (11:59 pm Central). The announcement will be made by no later than mid-January.
Name
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First Name
Last Name
Age
*
Gender
*
Year you will finish or did finish your orthopaedic residency or pediatric orthopaedic fellowship (whichever is latest)
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Hospital / practice / institution
*
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Your permanent address (if different from mailing address)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell phone
*
-
Area Code
Phone Number
Primary email address
*
Residency program director/ fellowship director - Name
*
(formal letter of recommendation required from this person)
Physician mentor- Name
*
(formal letter of support required from this person if different from residency program director/fellowship director)
Physician mentor- Specialty
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Physician mentor- Institution
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Physician mentor- Program
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Physician mentor- Email
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example@example.com
Proposed host country and city/region
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Proposed departure and return dates
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What are your local housing arrangements?
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I affirm that I have a valid passport and visa (if necessary) to travel to the country I have selected for the scholarship program.
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Yes
I affirm that I have received the necessary vaccinations and immunizations (if required) to travel to the country I have selected for the scholarship program.
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Yes
Appendix A: Letter of recommendation from residency program director or fellowship director.
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Appendix B: Letter from physician mentor with a summary of the proposed project – 500 words or less on the needs of the country/region, tentative timeline, target patient population, and list of local leaders and sponsoring organizations that have agreed to assist in this effort.
*
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Fill out and attach the photo release form,
click here
for form.
Upload your completed photo release form here:
*
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Provide a general overview of the proposed project.
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(500 words or less, expand text box as needed)
Please describe the work that you will be doing in the host country - that orthopedic conditions/settings do you anticipate seeing and what will your role be?
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(500 words or less, expand text box as needed)
Describe any previous international experience you’ve had.
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(500 words or less, expand text box as needed)
Submit
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