Bio-sketch fcc - Pediatric Ophthalmology
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1. AUPO FCC Faculty Information - Pediatric Ophthalmology
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For submitting multiple biosketches simply return to the ‘Pediatric biosketch form’ and repeat.
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1
. Faculty Member Biosketch:
Faculty Member Biosketch:
Parent Institution:
Affiliated Medical School or government training Institution:
Full name and degree:
Academic Title:
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2
. Are you voting member of AAPOS?
Are you voting member of AAPOS?
yes
no
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3
. Previous Training and Experience
Previous Training and Experience
Medical School Location:
Medical School Dates:
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4
. Previous Training
Previous Training
Residency Training Location:
Residency Training Dates:
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5
. Previous Training
Previous Training
Fellowship Training Location:
Fellowship Training Dates:
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6
. Previous Training
Previous Training
Post Fellowship Training Location:
Post Fellowship Training Dates:
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. Faculty member - Status: (please select ALL that apply; must select at least one)
Faculty member - Status: (please select ALL that apply; must select at least one)
Fellowship Director
Full Time
Part Time - Compensated
Part Time - voluntary
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8
. Faculty Member - Role: (please select all educational roles filled by this faculty member; must select at least one)
Faculty Member - Role: (please select all educational roles filled by this faculty member; must select at least one)
Surgery supervision
Didactic presentations
Research supervision
Supervise Fellow in clinic
Other
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9
. Faculty Member - Location: (please select the locations where this faculty member fulfills their role; must select at least one)
Faculty Member - Location: (please select the locations where this faculty member fulfills their role; must select at least one)
At home institution
Off-site
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10
. Faculty Member - Publications in major national/international peer-reviewed journals: (please list up to 10 maximum over the last 5 years)
Faculty Member - Publications in major national/international peer-reviewed journals: (please list up to 10 maximum over the last 5 years)
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11
. Faculty Member - Research presentations at major national/international meeting: (please list up to 10 maximum over the last 5 years)
Faculty Member - Research presentations at major national/international meeting: (please list up to 10 maximum over the last 5 years)
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