Bio-sketch fcc - Pediatric Ophthalmology
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1. AUPO FCC Faculty Information - Pediatric Ophthalmology

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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

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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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7. 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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Bio-sketch fcc - Pediatric OphthalmologyExit this survey >>

1. AUPO FCC Faculty Information - Pediatric Ophthalmology

*1. Faculty Member Biosketch:

*2. Are you voting member of AAPOS?

*3. Previous Training and Experience

*4. Previous Training

*5. Previous Training

*6. Previous Training

*7. Faculty member - Status: (please select ALL that apply; must select at least one)

*8. Faculty Member - Role: (please select all educational roles filled by this faculty member; must select at least one)

*9. Faculty Member - Location: (please select the locations where this faculty member fulfills their role; must select at least one)

*10. Faculty Member - Publications in major national/international peer-reviewed journals: (please list up to 10 maximum over the last 5 years)

*11. Faculty Member - Research presentations at major national/international meeting: (please list up to 10 maximum over the last 5 years)