Global Surgical Volunteer Application Form

Global Surgical Volunteer Application Form

The Volunteer Program is based on the principle of volunteerism where individuals volunteer to participate in activities of various local host programs (the “Host Program”) for up to two weeks. Volunteers in the Program further the development and improvement of neurosurgical training programs worldwide by assisting local faculty members, by cooperating in the neurological education in medical schools, and by assisting in neurosurgery training programs and graduation education courses. If you have additional questions about the program please contact Hamid Shah, FIENS Volunteer Coordinator at volunteer@fiens.org
Personal Information
Full Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Citizenship
E-mail
example@example.com
Phone Number
Please include country code
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Interests & Experience
Major Clinical and Research Interests
Language Spoken
Travel Experience
Volunteer Preferences

Most volunteer opportunities are for terms less than 1 month.
Desired length of volunteer participation
Dates Available for Volunteer Assignment
Preferred Location of Assignment
Preferred Location of Assignment

Volunteer Experience
Dates
Country
Comments
Dates
Country
Comments
Based on your previous volunteer experiences, what makes you want to repeat the experience of volunteering through the FIENS?
If you have not had any volunteer experience, what are your goals or expectations in becoming a volunteer through the FIENS?

Additional Information
Please state the country you are currently working in
Comments
Please attach your CV (Curriculum Vitae)

Cancelof
Are you interested in becoming a virtual volunteer for FIENS In Country Education Scholars? *Commitment is 1 check in call per month.
Please explain
Please state how you heard about FIENS
Should be Empty:

Personal Information