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 Jogi Pattisapu, FIENS Volunteer Coordinator at volunteer@fiens.org
Personal Information
Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Citizenship*
E-mail*
example@example.com
Phone Number*
Please include country code
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Medical Education
How many years of neurosurgical experience do you have post-residency?

1-5 years6-11 years12- 17 years18 + years

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*

1 month or lessOnly opportunities 2-3 months longLength of time depends on the opportunity
Dates Available for Volunteer Assignment
Preferred Location of Assignment
Preferred Location of Assignment

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

Cancelof
Are you interested in supporting FIENS in any sort of capacity outside of surgical mentoring?*

YesNo
Please explain
Please state how you heard about FIENs*

Website searchColleagueA neurosurgical society conferenceSocial media (X, LinkedIn, Facebook, YouTube
Should be Empty:

Personal Information