AAOS/OREF/ORS Clinician Scholar Career Development Program Application
The completed application, curriculum vitae, and letter of support from your department chair must be submitted by 11:59 PM CST on March 31, 2018. Applicants will receive a confirmation email from JotForm when submitted. Inquiries may be sent to csdp@aaos.org.
Name
*
First Name
Last Name
Suffix
Email
*
example@example.com
Current Employer Address
*
Institution
Street Address
City
State / Province
Postal / Zip Code
Home / Permanent Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact Number
*
-
Area Code
Phone Number
Postgraduate Year
*
PGY-1
PGY-2
PGY-3
PGY-4
PGY-5
N/A
Other
AAOS Member ID
*
Member Type
*
Resident Member
Candidate Member
Fellow
Other
Education (Institution / Years Attended / Degrees Earned)
*
Relevant Research Activity (Project Title / Location / Begin and End Dates / Funding)
*
PERSONAL STATEMENT: Provide a short statement approximately 500-words (not to exceed 3900 characters) including the following information: Statement of potential impact on your career / how the CSCDP will enrich your professional development / statement of potential impact on orthopaedics.
*
0/3900
CAREER GOALS: Provide a description of your current career goals, your 5-year career goals and your 10-year career goals.
*
Specialty Society Membership(s) (check all applicable):
*
American Association for Hand Surgery
American Association of Hip and Knee Surgeons
American Orthopaedic Foot and Ankle Society
American Orthopaedic Society for Sports Medicine
American Shoulder and Elbow Surgeons
American Society for Surgery of the Hand
American Spinal Injury Association
Arthroscopy Association of North America
Cervical Spine Research Society
Hip Society
J. Robert Gladden Orthopaedic Society
Knee Society
Limb Lengthening and Reconstruction Society
Musculoskeletal Tumor Society
North American Spine Society
Orthopaedic Rehabilitation Association
Orthopaedic Research Society
Orthopaedic Trauma Association
Pediatric Orthopaedic Society of North America
Ruth Jackson Orthopaedic Society
Scoliosis Research Society
Society of Military Orthopaedic Surgeons
NO SPECIALTY SOCIETY MEMBERSHIP
Specialty Interest Areas (check all applicable)
*
No Specialty Area
Adult Hip
Adult Knee
Adult Spine
Arthroscopy
Disability/Legal Orthopaedic
Foot and Ankle
Hand
Non-Operative Practice
Orthopaedic Oncology
Pediatric Orthopaedic
Pediatric Spine
Rehabilitation/Prosthetics/Orthotics
Shoulder and Elbow
Sports Medicine
Total Joint
Trauma
Other
UPLOAD CV
*
Browse Files
PDF Preferred
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of
UPLOAD LETTER OF SUPPORT
*
Browse Files
Letter of support must be on institution letterhead and signed by supervisor / department head. PDF preferred.
Cancel
of
2018 Clinician Scholar Career Development Program Application Certification:
*
I certify that all of the statements in this application are true, complete, and correct to the best of my knowledge and belief, and are made in good faith.
Submit
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