Gillingham Pan-American Fellowship Program Application

Application submission deadline: October 1, 2023

Up to two (2) fellowships in the amount of $10,000 each are offered to qualified Latin American (Mexico, Central, or South America) candidates who have been accepted into an accredited training program in the United States and Canada. The applicant should be no more than 2 to 3 years out of his/her residency program. The candidate must be a member of the PAAO.

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If you have any question, please contact the Administrative office (817-275-7553 or [email protected])

Application materials:

Applications documents should be numbered/named in accordance with the list below. (1_CV_applicant name; 2_letter of interest_applicant name; 3_letter of recommendation; 4_application proof_applicant name; 5_proof of acceptance_applicant name). If sending multiple recommendation letters, please number them 3a, 3b, 3c, etc.

1. Curriculum Vitae (CV), 2-3 pages

2. Letter of interest

3. Letter of recommendation

4. Proof of application to an accredited fellowship program, and/or

5. Proof of acceptance into an accredited fellowship program (due by February 1, 2022)

6. Scan or photo of passport

SUBMIT APPLICATION BELOW

Here we have provided the guidelines you can print out for your information.

Gillingham Pan-American Fellowship guidelines (PDF) Gillingham Pan-American Fellowship guidelines (DOCX)

Funding provided by Retina Research Foundation of Houston, Texas.

Gillingham Pan-American Fellowship Program (1)

PAAO ID*

Please contact PAAO Office if you don’t know your membership ID number or get it by logging into network.paao.org
Name of Applicant*
First Name Last Name(s)
Degree(s)*
Birth Date dd/mm/yyyy*
DD slash MM slash YYYY
Email*
Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Mobile Phone
Office Phone
Current Training Program
Complete contact information of the Department Chair or Program Director who is recommending you to for this scholarship.
Program Director/Department Chair*
Full Name, Degree(s) (MD, PhD)
Institution*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Training Start Date*
DD slash MM slash YYYY
Training End Date*
DD slash MM slash YYYY
Accepting Program
Name of the Institution to which you have been/will be accepted. Make sure to include the name of the Program Director who will be supervising your training and as well as dates of the training program.
Program Director/Department Chair*
Full name, Degree(s) (MD, PhD)
Institution*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Mobile Phone of supervisor chief/director
Email
Training Start Date*
DD slash MM slash YYYY
Training End Date*
DD slash MM slash YYYY
Subspecialty Field of this program:*
Application Materials
Please upload all of the supporting documents required for you application. Max size per file is 128 MB
1. Photo (professional looking headshot)
2. Curriculum Vitae (CV)
3. Letter of interest
4. Letter of recommendation
5. Confirmation of acceptance by an accredited training program
OR Copy of the letter of application to an accredited training program with acceptance letter to be submitted by February 1 to [email protected]
6. Photocopy of passport
Application Materials*
Drop files here or

Accepted file types: doc, pdf, jpg, png, Max. file size: 100 MB.
See list above.
Files must be word doc, PDF, JPG or PNG
Agreement
Please read and check each box below confirming you agree.
*
- I have read and accepted the above terms and responsibilities for a Pan-American Scholarship.
*
- I understand that noncompliance will be grounds for termination of the scholarship.
*
- I understand that I am obligated to return to my country of origin and submit a report on my activities during the scholarship stay.
*
- I further understand that I am obligated to be an Active Member or a Member-in-Training of the Pan-American Association of Ophthalmology at the time of application.
*
- I assume entire responsibility and hereby agree to protect, indemnify, defend, and save the Pan-American Ophthalmological Foundation (PAOF) and the Pan-American Association of Ophthalmology (PAAO) and their employees and agents, harmless against all claims, losses and damages to persons or property, governmental charges, or fines and attorney’s fees arising out of or caused by my participation in the Gillingham Pan-American Fellowship Program. In addition, I acknowledge and understand that the PAOF and PAAO do not obtain and maintain insurance and that it is my sole responsibility to obtain medical, malpractice, property, life, and travel insurances as deemed necessary by the fellowship program.
Consent*
I agree to the PAAO Privacy Policy
Name*

By typing my name here I am confirming the above statements are true and it will act as my full signature.
Today's Date*
DD slash MM slash YYYY
Name
This field is for validation purposes and should be left unchanged.

Disclaimer: Employees of the Pan-American Association of Ophthalmology (PAAO), Pan-American Ophthalmological Foundation (PAOF), members of the PAAO Executive Committee, members of the PAOF Board of Directors, their immediate family members and members of the same household, whether related or not, are not eligible to apply for scholarship/fellowship funding. All scholarships are subject to federal laws and regulations and are void where prohibited by law or regulation. Applicants agree to abide by the terms of these official rules and by decisions of the Review Committee which are final and binding on all matters pertaining to the scholarship/fellowship. The PAAO & PAOF reserve the right to disqualify any applicant that they determine, in their sole discretion, to be ineligible to participate in the scholarship/fellowship program. Individuals who have previously received travel awards/scholarship/fellowship funding are ineligible to apply for additional awards/ funding.

Gillingham Pan-American Fellowship Program Application

Application submission deadline: October 1, 2023

MORE INFORMATION

Gillingham Pan-American Fellowship Program (1)

Current Training Program

Accepting Program

Application Materials

Agreement

Tribute Card

Recipient Information

Giver Information

Your application has been submitted.

You will be contacted when the recipient has been selected. If you have questions please email [email protected]