The Hip Society's 2023 Rothman-Ranawat Traveling Fellowship Application

Deadline to complete this application is August 15, 2022, by 11:59 pm US CDT.
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!  Read the criteria below carefully.  All boxes must be checked in order to proceed and be considered eligible for the program.  Please contact The Hip Society (hip@hip-knee.org) with any questions.
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Please sign this Affidavit portion (use your mouse or other navigation device to sign). *
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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). *
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