• IUGA Fellowship Development Mentorship Program Application Form

  • About: Urogynecology and Reconstructive Pelvic Surgery (URPS) physicians provide consultation services and comprehensive management of women with pelvic floor disorders (PFD), including urinary incontinence, lower urinary tract disorders, pelvic organ prolapse, sexual dysfunction, colorectal-anal disorders and childbirth-related injuries. Comprehensive management includes the preventive, diagnostic, and therapeutic procedures necessary for the total care of the female patient with these conditions, complications, and sequelae resulting from PFDs.

    The IUGA Fellowship Development Mentorship Program is designed to support the development of new fellowship programs globally, aligned with the standards of countries where Urogynecology is recognized as an official sub-specialty, such as the U.S.A., U.K., Australia, and The Netherlands.

    The application process follows three steps before the final applicant/s is selected:

    1. Application form is completed 
    2. Panel review of applications 
    3. Interview 
    4. Notification of acceptance to program

    Please complete the following application to request mentorship in developing a Urogynecology and Reconstructive Pelvic Surgery Fellowship Program.  This application requests information that focuses on areas to show readiness, challenges, and resource needs (Infrastructure and requirements) in fellowship program development. 

     

    Before completing this application, please review the IUGA URPS Fellowship Development Guidance Document, which outlines the expected training standards and competencies. The document is available on the Fellowship Development Mentorship Program page. Click here to review it.

  • SECTION 1: Demographics

  • It is mandatory to have a letter of Support from your department/institution/Hospital. If No, you cannot continue this process until you have the required support.

  • SECTION 2: Applicant’s Experience & Faculty

  • Undergraduate Medical Education:  

  • Postgraduate Training (Residency/Fellowship):

  • If yes, please complete the field below. If no, leave it blank.

     

  • Fellowship Faculty: Please list the additional members of your faculty and their credentials

  • Faculty member 1

  • Faculty member 2

  • Faculty member 3

  • SECTION 3: Multidisciplinary Clinics

  • Rows
  • SECTION 4: Clinic Support Services 

  • SECTION 5: Surgical Procedures 

  • Rows
  • SECTION 6: Research Resources and Support 

  • SECTION 7: Accreditation Body

  • SECTION 8: Education Curriculum

  • Section 9: IUGA Participation

  • If you selected IUGA regional symposia, funded grants for observerships and research, or international fellowship grants, please specify below

  • Section 10: Local or National Urogynecology Support

  • Attachments Required:

  • Please attach/upload the following documents in PDF format:

  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Should be Empty: