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Application form for International Exchange Program

Welcome to the AO Spine observership application form.

Please press “submit” when you have entered all your data including the attachments. If you experience any problems entering your data, please contact our Fellowship Support by e-mail [email protected].

Personal Information

Complete name

AO ID

Date of birth

Nationality

Contact Details

Address

Zip code

City

Country

Telephone

Cell phone

Languages

Native ‘mother tongue’ language

Other languages

AO Educational History

Have you attended an AO Spine Fellowship in the last two years?

Yes

Have you registered on the Continuing Education program?

Yes

Have you attended one AO Spine advanced course?

Yes

Have more than three-year experience in spine surgery:

Yes

Current Employment

Present position

Hospital name

Head of department

Zip code

City

Country

Medical School

Name of facility

Graduation date

Zip code

City

Country

Post Graduate Education

Name of facility

Graduation date

Field

Qualification

Details about subspeciality training in spine Subspeciality

Research Work

Are you active in research?

Yes

Publications

Have you published any research papers?

Yes

Observership

1st choice

What is your 1st topic of interest? Area of interest

Hosting center

Duration

2nd choice

What is you 2nd topic of interest? Area of interest

Hosting center

Duration

Most convenient date(s) to start

1st choice

2nd choice

What do you expect to improve with the observership? Expected improvements

Remarks

Supporting Documentation

We required the following documents:

Curriculum vitae;
Copy of the most recent AO Spine Advanced course Certificate;
Copy of the orthopedic or neurosurgery specialization certificate;
Letter of recommendation from a senior surgeon (recommended to mention the participant has more than three-year experience in spine surgery)
Proof proficiency language. * Participants in countries with language other than their own must attest advanced knowledge in English or in the local language (depending upon the center requirements). Proficiency in English is to be attested by an international recognized certificate such as IELTS, TOEFL or equivalent.