2027 YES International Service Grant Application

International Service Grant Application

Young Eye Surgeons
Full Name

First NameLast NameDegree(s)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Current Position, location, and start date (and end date if in training)
Residency Program, Location, and Date of Completion
Fellowship Type, Location, and Date of Completion
Sub-specialization(s), if any
Domestic and/or International Volunteer Experience
Describe how you envision using this grant: For personal enrichment in global ophthalmology, or to do a project providing education, training or research in a developing country? Please list the main components, location, timeline, $5,000 budget allocation, and, if applicable, supporting mentors/program.
What do you hope to accomplish (short term and long term) and how would this project impact your commitment (ability?) to being a lifetime participant in global ophthalmology?
Applicant CV and References

Instructions:
1. Upload your resume or CV.
2. Provide the contact information for three references in the requested field.
3. One letter of recommendation from one of your references is required. Upload the letter of recommendation (no more than one page in length) addressing both your clinical and surgical skills along with your character.
Resume/CV

Cancelof
Letter of Recommendation

Cancelof
Is your ASCRS membership active?
What language(s) do you speak? Please include level of fluency.
Research Experience (Please summarize. Do not list papers.)
Experience in Public Health (if applicable).
Is there anything else you'd like us to know? (e.g. Technical/Managerial/Entrepreneurial Experience)
Reference 1
Include name, affiliation, phone, and email. Letter required below.
Reference 2
Include name, affiliation, phone, and email.
Reference 3
Include name, affiliation, phone, and email.
You must complete your project including travel by April 2028. Describe what you will do with your grant in your host country to prepare for your visit.
Should be Empty:

International Service Grant Application

Applicant CV and References