PGA80 International Scholars Application PDF Form

PGA80 banner

International Scholars Application

The New York State Society of Anesthesiologists, Inc.

80th PostGraduate Assembly in Anesthesiology

December 11 - 14, 2026 • 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, 2026, 11:45 PM EST

Name*

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

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:*

ExcellentGoodSatisfactory

Country of citizenship*

Passport number*

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

YesNo

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

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.*

I agree.