DEADLINE: September 15 & March 15 (Deadline extended to April 1, 2016)
Please make sure that your program director has also submitted his or her recommendation by the deadline.
Please do not hit the enter button when completing the fields below
a general description of your overseas elective:
What is your
motivation for seeking such an elective, and how will it affect your
What will you
do while you are there? Include information on the kind of facility
and your objectives.
What kind of preparations
have you made for your trip? (Immunizations, Visa(s), passes, housing
arrangements while abroad).
If there will
be a language barrier, how will you handle it?
You must make
arrangements for medical care should you become ill. What preparations
have you made?
describe any previous international experience you have had?
The elective award is payable to your institution for tax purposes. The check can be payable to you; however, you will be taxed on the award and receive a 1099 form from the AAP for the calendar year in which you received the award.
Please make the check payable to:
(Resident) hereby certify that all the questions on the application
form have been answered completely and accurately to the best of my
Please provide the information below for the person (program director, faculty mentor/advisor, or global health director) submitting the recommendation on your behalf. He or she will receive the link to the recommendation form once your application is submitted and processed.
Name and Address of Training Program
Name of Faculty Mentor/Advisor or Program Director
Faculty Mentor/Advisor or Program Director/ E-mail Address
Faculty Mentor/Advisor or Program Director Street
Faculty Mentor/Advisor or Program Director City
Faculty Mentor/Advisor or Program Director State
Faculty Mentor/Advisor or Program Director Zip
**Please review for accuracy **