Application (Format) For Foreign Fellowship, IOA

(Please mention the name of the fellowship applied for)

1. Name ………………………………………………………………………………………………………………………

Age ................................………….Sex…………………………………………..

IOA Membership number (No dues to IOA)

Membership in years.

Postal Address.......................................................……………………………………………………………….

……………………………………………………………………………………………………………………….

City …………………………………………………………………………Pin …………………………………………………..

PhoneNo. ( ) ………………………………………………( )…………………………………………

FaxNo. ( ) ..................................................................
2. Qualification (With month & Year of Qualifying)
3. Present Appointment
a. Nature and date of appointment and Leaving/ retiring
b. Number of Orthopaedic beds.
c. Teaching work done
5. Professional Experience
Date of joining the Orthopaedic profession.
(Authenticated Xerox copy of state medical council certificate must be attached.)
6. Articles published in journals and papers presented in conferences
a. Papers Published
b. Books Published
c. CME Lectures and papers presented
7. Have you been abroad in the last three years? if yes where and when and the purpose of visit.
8. Have you availed of foreign fellowship any time?
9. Can you leave for fellowship at the scheduled time?
10. Are you willing to meet all your expenses abroad incurred in excess of the fellowship Award money?
11. Do you propose to visit any other centre or work of interest in country to be visited?
12. What research project you have under taken recently?
13. Will you be available for interview by Overseas fellowship committee at your own expense at the time of IOACON.
14. State briefly how the fellowship will benefit you and the institute where you are working. Complete application with
Xerox copies of all the authenticated certificates must be received by Secretary Foreign fellowship Committee, IOA.
BEFORE
September 15, of year of application
Please send your application by Registered A. D. Post Parcel only

Form Courtesy: IOA Website http://www.ioaindia.org

 Guide Lines To The Applicant

1. Only Life and Full members of IOA, without any dues, are eligible.
2. Eight sets of copies of the Curriculum Vitae, Bio-data, application and the relevant authenticated Xerox copies of the documents
must reach the Fellowship Secretary before September 15, each year. Authenticated Xerox copy of Birth Certificate, School Leaving
Certificate or Passport must be attached for age verification of the applicant.
3. Original Certificates must not be submitted as they will not be returned.
4. Member selected in past for any overseas / foreign fellowship of 10 A is not eligible to apply.
5. Applicant must apply for only one fellowship.
6. Any change in address / phone no. must be immediately informed to the fellowship secretary.
7. Any wrong information or canvassing will disqualify the applicant.
8. Only written communication will be entertained.
9. Only selected candidate will be informed.
10. Application must be sent by registered A. D. post only, and no receipt will be sent.
11. Authentication must be by a Gazetted officer, Head of the institute, Current President or Secretary of the State Chapter to which
the applicant belongs to.
12. Applicant must have a valid passport and shall obtain Visa to travel in proper time.
To submit a completion report to the Inland Fellowship; Secretary within a month of completion of the fellowship. APPLICATION FORMAT FOR
INLAND FELLOWSHIP OF IOA

Please tick the fellowship you are applying for and make the application in the prescribed format as it will be graded as such, (see Part II )
Applications not in the prescribed format or without proof of documentation will be rejected. Please send nine copies the application
The Johnson & Johnson/Robert Roaf Travelling Fellowship
The Dr. S.S. Babhulkar Fellowship

PERSONAL PARTICULARS
Name
Age/Date of Birth
Address
Phone No.
Fax.
Email Address
IOA membership No. Since when
(these fellowships are open to IOA members only)

REFERENCES
Please arrange for two senior colleagues with whom you have worked in the last three years to write independently to the Inland
fellowship Secretary
SUMMARY OF BIO-DATA
Please provide nine copies of a short summary of your bio-data. (This is for transmission to the host centres for your introduction if
selected for the fellowship)
CERTIFICATION
Please certify that all information given by you is correct. Please attach one set of all necessary documentation.
POST GRADUATE QUALIFICATIONS 5 marks
IN ORTHOPAEDICS
Qualification Date of obtaining EXPERIENCE 10 marks
Present appointment
Nature and.date of appointment
Number of orthopaedic beds
Teaching/non teaching
Specialized work
Research work
Past appointments
Nature and dates of appointment and leaving
Number of orthopecdic beds
Teaching/non teaching
Specialized work
Research work
PUBLICATIONS 40 marks
One photo copy of each publication required. Please tabulate your publications under the following headings:
Indexed Journals/Indian Journal Of Orthopaedics
Non indexed Journals
Books/Monograph/Book chapter PAPERS/POSTERS PRESENTED PERSONALLY 10 marks
BY APPLICANT
International conferences abroad
International conferences in India/IOACON
Subspeciality/state chapter conferences

GUEST LECTURES/LECTURES AT CME/10 marks

WORSHOPS
International conferences abroad
International conferences in India
IOACON
Subspeciality/State Chapter conferences

Form Courtesy: IOA Website http://www.ioaindia.org