NYSSA/PGA International Scholars Application

International Scholars Application

The New York State Society of Anesthesiologists, Inc.

79th PostGraduate Assembly in Anesthesiology

December 12 - 15, 2025 • New York City

Please note: Preference will be given to residents and recent graduates. Previous scholarship recipients will not be eligible. Only complete applications will be considered.

Deadline: June 30, 2025, 11:45 PM EST

Name*

First NameMiddle NameLast NameCredentials (e.g. M.D.)

Gender*

FemaleMaleNon-binary

Date of birth*

Email*

example@example.com

Mobile phone*

Country CodeArea CodePhone Number

Home address*

Street Address

Street Address Line 2

City

Postal codeCountry

Hospital address*

Name of hospital

Department

Street AddressCity

Postal codeCountry

Please indicate how you heard about this program:*

Fluency in the English language:*

ExcellentGoodSatisfactory

Country of citizenship*

Passport number*

Do you currently hold a visa to attend the meeting in the US?*

YesNo

Upload a copy of your United States visa if you answered "Yes" above.*

If you do not currently hold a US visa, consult the estimated wait times for obtaining a visa. https://travel.state.gov/content/travel/en/us-visas/visa-information-resources/wait-times.html

Have you attended any international conferences?*

YesNo

If you answered "Yes" above, please list the conference(s) below.*

If accepted, you will have the opportunity to submit a medically challenging case for presentation at PGA79 and will have a mentor assigned to work with you virtually in the write-up of your case. Please indicate if you are interested below.*

YesNo

Education/postgraduate training (include name of program, dates of study and location):*

Professional organizations (include level of involvement and any leadership roles):

Most recent publications:

Current research interest:*

Describe your current practice in anesthesiology.*

Why do you want to attend the PostGraduate Assembly in Anesthesiology?*

Include a letter of recommendation from your department chair.*

Upload a headshot/photo of yourself for a slide that will be presented during the Opening Ceremony if you receive a scholarship.*

The scholarship will cover the registration fee and accommodations. By checking the box below, you agree that you will cover all other related expenses (ground travel, meals, etc.). You will need to provide a credit card for the hotel at check-in which will be authorized for $100 USD per day, at a maximum of $600.*

I agree.

In order to maximize the number of scholars accepted to PGA79, you will be assigned a roommate of the gender selected in this application. Only yourself and your roommate may stay in the room (significant others, friends, et al. must arrange separate accommodations).*

I agree.