The Knee Society John N. Insall Traveling Fellowship

This application is now open for the 2025 traveling cycle. Deadline to complete the application is October 1, 2024, 11:59 pm US Eastern Time.

ELIGIBILITY: PLEASE READ CAREFULLY

A successful applicant:

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

- May be from North or South America, Europe, Asia, or Australia; selection will be at the discretion of the committee;

- Must have exhibited interest in clinical or laboratory research;

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

- Must be able to take the tour (four (4) weeks) in the Fall following application deadline (i.e., deadline October 1 the year prior to travel; travel October 1 through October 31 the following year). Applicant must have completed either an Adult Reconstruction Knee Fellowship or Sports Medicine Fellowship.

BY CLICKING THE BOX BELOW YOU CERTIFY THAT YOU HAVE READ, UNDERSTOOD, AND AGREED WITH THE STATED ELIGIBILITY CRITERIA, AND THAT YOU CONFIRM YOUR ELIGIBILITY. *

I agree and confirm.

INSTRUCTIONS

1. Complete the application form in its entirety. With any questions, please contact Sarah Benavidez Benavidez.Sarah@mayo.edu. All applications will be forwarded to the Selection Committee. A recent (within 2 years) headshot must be uploaded when completing this application process.

2. Two (2) maximum sponsor letters must be uploaded when completing this application process. The letters must be on a letterhead and signed. One sponsor should be an orthopaedic surgeon who is familiar with your work during your residency or fellowship, and the other should be an orthopaedic surgeon who is familiar with your work as a practicing physician.

3. The entire application and additional documentation must be completed and uploaded by October 1 the year prior to travel. Incomplete applications will not be considered.

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ABOUT YOU

Your full name (first, middle, last or family name): * 🛈

Date of birth * +

Age as of October 1, 2023 (full years only): *

City/Town and Country of Birth: *

For US applicants only - last 4 digits of your SSN: *

Upload your recent headshot: *

Institution: *

Business address: *

Business address line 2:

City/Town: *

State/Province/Territory: *

Postal or ZIP Code: *

Country: *

Business phone (with area and country code): *

Primary email: *

Home address: *

Home address line 2:

City/Town: *

State/Province/Territory: *

Postal or ZIP code: *

Country: *

Mobile Phone *

Alternative email:

YOUR SPONSORS

Sponsor 1: Full name and professional credentials: * 🛈

Sponsor 1 institution: *

Sponsor 1 email: *

Upload letter of recommendation from Sponsor 1: * 🛈

Sponsor 2: Full name and professional credentials: * 🛈

Sponsor 2 institution: *

Sponsor 2 email: *

Upload letter of recommendation from Sponsor 2: * 🛈

YOUR EDUCATION AND PROFESSIONAL INTERESTS

Describe the area of your special interest in orthopaedics: *

Graduate of (use the TAB key to scroll through the columns): *

	Name	Location	Graduation (month/year)
College/University	Name	Location	Graduation (month/year)
Medical School	Name	Location	Graduation (month/year)

Postgraduate education: list residency rotations (use the TAB key to scroll through the columns): *

	Name/location	From (month/year)	To (month/year)
PGY1	Name/location	From (month/year)	To (month/year)
PGY2	Name/location	From (month/year)	To (month/year)
PGY3	Name/location	From (month/year)	To (month/year)
PGY4	Name/location	From (month/year)	To (month/year)
PGY5	Name/location	From (month/year)	To (month/year)

Additional education or fellowship (use the TAB key to scroll through the columns):

	Type of education or fellowship	Location	Name of director	From (month/year)	To (month/year)
1.	Type of education or fellowship	Location	Name of director	From (month/year)	To (month/year)
2.	Type of education or fellowship	Location	Name of director	From (month/year)	To (month/year)

Date of ABOS certification or eligibility: * +

Date of North American Credentialing Board certification/eligibility: +

Member of AAOS? *

Yes

Date of membership: +

Date of fellowship: +

Member of non-US equivalent of AAOS:

Yes

Name of organization:

YOUR PROFESSIONAL CAREER

Teaching affiliations: please list in chronological order beginning with the most recent (use the TAB key to scroll through the columns):

	Name of center	From (month/year)	To (month/year)	Academic title
1.	Name of center	From (month/year)	To (month/year)	Academic title
2.	Name of center	From (month/year)	To (month/year)	Academic title

Briefly describe your future career plans: *

UPLOAD YOUR CURRICULUM VITAE BELOW. BE SURE TO USE THE FOLLOWING COMPLETE HEADINGS (a-t) TO BEGIN EACH NEW SECTION OF YOUR CURRICULUM VITAE. IF FOR ANY SECTION THERE ARE NO CONTRIBUTIONS, THEN PLEASE, AFTER THE SECTION HEADING TYPE THE WORD “ NONE”.
a. Name of applicant
b. Special awards (List special awards you have received while in College, Medical School, Residency, Fellowship, or following the completion of your educational program; Outstanding Resident Award, Best Teacher Award, etc.)
c. List of scientific presentations which you have made as an author or co-author at any National and International meetings (include title of paper, organization, location, and date).
d. List of scientific presentations, which you have made as author or co-author at any regional, and local meetings (include title of paper, organization, location, and date). Start with peer reviewed abstract presentations at regional meetings.
e. List of all the movies, sound slide programs, exhibits, audio tapes, and video tapes, which you have developed or co-developed. You should also list the scientific meetings where each has been presented.
f. List national, regional, and local post graduate courses or meetings that you have organized or hosted.
g. List of national, regional and local professional medical organizations or societies to which you belong.
h. List the committee appointments that you have received in the above medical organizations.
i. Describe any special non-medical and non-academic achievements or activities and interests which you
believe are important, i.e., civic activities, Church, Boy Scouts, Chamber of Commerce, etc. It is important not to overlook this section in that this helps to give the Committee a better sense of the depth and breadth of your intent outside orthopaedic surgery.
j. List committee appointments at medical school/local hospitals.
k. List the research grants that you have received and the source. List all of the authors in their proper sequence and amount of each grant. List your involvement in each grant (i.e. principle investigator, associate investigator). Start with NIH funding, OREF funding and any other competitive grants. Then follow with extramural non-competitive grants including industry
and intramural non-competitive grants.
l. List the articles you have published in peer reviewed journals. List the name of the article, journal name, authors, page numbers and the year. Please underline your name and capitalize the name of the journal.
m. List the papers you have published in non referred journals. List the name of the article, journal name, authors, page numbers and the year. Please underline your name and capitalize the name of the journal.
n. List of published abstracts. Start with abstracts in Orthopaedic Transactions and Orthopaedic Research
Society.
o. List of peer reviewed publications in press. List of peer reviewed publications submitted.
p. List of non-peer reviewed publications in press. List of non-peer reviewed publications submitted.
q. List textbooks or chapters in textbooks that you have written or edited. Identify title, publisher and the year.
r. List the manuscripts that you have submitted for publication. Identify the article and the journal.
s. Describe clinical and basic research work that is now in progress. SINCE THIS SECTION IS WEIGHTED HEAVILY, IT IS TO YOUR ADVANTAGE TO ADEQUATELY COMPLETE THIS PORTION.

Upload your Curriculum Vitae here (Word or PDF files only). *

Write a personal, one-paragraph statement; stating why you feel you would be a good Insall Travelling Fellow representative and a “Good Will Ambassador” for The Knee Society and The Insall Travelling Fellowship. *

Your signature (use a stylus, a mouse or another navigation device to sign): *

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Date application is completed: * +