The Hip Society's 2024 Rothman-Ranawat Traveling Fellowship Application

Deadline to complete this application is January 10, 2024, by 11:59 pm US CST.

Completing the application is the responsibility of the applicant. Applications that are not complete once the deadline passes (i.e., missing information and/or items)

will not be considered.

By completing this application form, you agree to share with The Hip Society, its employees, volunteers, and agents, your personal and contact information. Please review The Hip Society's Privacy Policy.

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ELIGIBILITY AFFIDAVIT
Very important! Please contact The Hip Society (hip@hip-knee.org) with any questions.

A successful candidate MUST meet ALL of the following criteria. Candidates may be from Asia, Africa, North America, South America, Europe, or Australia; selection will be made solely at the discretion of The Hip Society's Fellowship & Mentorship Committee. All decisions are final.

- Must be board-certified / board-eligible practicing orthopaedic surgeon in your country of residence/practice.

- Must be at least five (5) years from completion of training in the specialty of hip surgery (having completed a fellowship in either adult reconstruction, sports medicine or hip joint preservation).

- Must have exhibited interest in clinical or laboratory research and able to demonstrate documented interest in advancing hip surgery via publications, presentations, research.

- Must be willing to individually or collectively complete projects determined by The Hip Society and present, either individually or collectively, at a subsequent national meeting

- Must be able to be away from home/practice on a 4-5-week tour in November-December 2024, and able to obtain an entry visa(s) for the United States and Canada. (The Hip Society will provide a letter of invitation upon request to selected Fellows. The Hip Society will not assist with the visa application process nor will reimburse any associated expenses. Please allow adequate time for visa processing.)

I certify that I am eligible based on the above criteria and am able to present documented proof of any of the above if requested. *

I CERTIFY

Please also check the below: *

I am fluent in spoken and written English.

I am not a previous Hip Society Rothman-Ranawat Traveling Fellow.

Your Last (Family, Surname) Name: *

Your First (Given) Name: *

Middle Initial(s):

Your date of birth: * +

Your age as of January 1, 2024 (full years only): *

Your headshot (100 MB maximum) * 🛈

Please sign this Affidavit portion (use your mouse or other navigation device to sign). By signing you agree that your electronic signature carries the same weight as your handwritten one. *

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HEALTH INFORMATION

COVID-19 Restrictions on Travel to the US and Canada

Please read carefully and check back for updates as information changes quickly.

US Department of State

Canada Border Services Agency

Proof of Vaccination for Hospital Observerships

Proof of acceptable vaccination will be required, including but not limited to, Hepatitis B, flu, MMR, varicella, Tdap. Proof of a negative TB test and/or a full chest Xray also may be required.

All candidates must be willing and able to obtain the necessary documentation ahead of travel.

Please sign to indicate your agreement with, and understanding of, the the above Health Information (use your mouse or other navigation device to sign). By signing you agree that your electronic signature carries the same weight as your handwritten one. *

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