2019 ACAPS Global Health Committee
ASPS Education Network Scholarship


Deadline for Scholarship application is due Monday, January 6th, 2020

  1. Refer to criteria below for eligibility requirements.
  2. If any question does not apply to you in this application, please put N/A in the space.
  3. You will be notified by email regarding the status of your application.
  4. If you have any questions about the application or scholarship, please contact the ACAPS Main Office.

Purpose: To provide a one-year subscription, starting February 1, 2020, to the ASPS Educational Network for a surgical trainee or surgical training program from a resource poor area.

Award Components: One year subscription to the ASPS Educational Network for one surgical trainee or surgical training program selected by the American Council of Academic Plastic Surgeons (ACAPS) Global Health Committee and approved by the American Society of Plastic Surgeons (ASPS) and the Editorial Board.

Criteria:

  1. Applicant must be a surgical trainee or a trainee acting as the representative of a surgical training program who is actively pursuing clinical plastic surgery education.
  2. Applicant must be actively enrolled in a surgical training program that includes clinical plastic surgery in a low or middle-income country.
  3. Applicants must prepare an essay on what they plan to do with their plastic surgery education after completion of their surgical training.
  4. Applicant must provide two (2) letters of reference from educators, supervisors, and/or current Program Director.
  5. Applicant must submit a current CV.
Application Type
Individual Plastic Surgery Trainee Plastic Surgery Training Program
Training Program
Program Name
City
State:
Number of surgical Trainees in Program Requesting ASPS Access
Program Director
First Name: Last Name: Middle:
Applicant Information
First Name Last Name Middle
Date of Birth
Day    Year
Address
City
State
Country
Home Phone
Work Phone
Email
Alternate Email
Gender
Male
Female
Prefer not to say
FINANCIAL POSITION
Does Your Training Program Provide You with Financial Support?
Yes No

If Yes, How Much Annually? (US Dollars)
Do You Have Another Source of Income?
Yes No

If Yes, Please Describe the Souce
Please Enter the Amount (US Dollars)
Total Annual Income (US Dollars)
SECONDARY EDUCATION
Name of School Location Dates Attended
UNIVERSITY EDUCATION
Name of School Location Dates Attended Degree & Date
MEDICAL EDUCATION
Name of School Location Dates Attended Degree & Date
POST GRADUATE TRAINING
Name of School Location Dates Attended Graduated?
Current Training Program
Name of Program Program Director Number of Faculty Duration of Training
Program Description
(Please provide a brief description of the program structure, clinical and didactic curriculum, and level of faculty supervision)
Program Resources
(Please provide a brief description of the access to computer equipment, internet availability, and educational resources)
Honors & Awards
Honor/Award Year Description
References
First Name Last Name Email Phone Relationship
Upload Reference Letter #1
Upload Reference Letter #2
Personal Essay

(Word limit: 500)
If you receive a scholarship, would you be willing to volunteer to serve on the ASPS Editorial Committee following your training, to help contribute and further develop the site?
Yes No
Upload your CV
Upload your Photo

 
 
American Council of Academic Plastic Surgeons
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Phone: 978-927-8330 | Fax: 978-524-0498