ACEPS International Visiting Professor/Trainee Scholarship Application

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* 1. Institution

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* 2. Address

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* 3. Faculty Name

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* 4. Faculty Email

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* 5. Trainee Name

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* 6. Trainee Email

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* 7. PGY level:

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* 8. Program Type:

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* 9. Plans after completion of residency training:

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* 10. Fellowship:

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* 11. Practice Type:

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* 12. Upload CV

PDF, DOC, DOCX file types only.

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* 13. What do you expect to gain from this educational exchange trip?

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* 14. How can you contribute to this educational exchange trip?

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* 15. Have you had any previous experience with global health activities or educational exchange programs?

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* 16. How will this scholarship address deficiencies in the hosting international program's training?

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* 17. How will you use the newly acquired knowledge or skills in your practice or community?

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* 18. Do you plan to maintain the collaboration with the international training program and if yes, in what way?

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* 19. If awarded the scholarship, are you willing to provide feedback to the ACAPS Global Health committee after visiting an international training program?