Application for International Medical Fellowship

In addition to this application, the below items should be submitted. (You can fill out the application now, and send these items later if you choose.)

• - Cover letter and resume - Please include your international and/or medical experience (if any)
• - Short video of yourself - Please tell us why you would be a great asset to our team and how you heard about AfS.

Applicant Name

First Name (required)

Last Name (required)

Suffix

Preferred Nickname

Applicant Address

Address 1 (required)

Address 2

City (required)

State (required)

Zip/Postal Code (required)

Country (required)

Home Phone

Cell Phone

Your Email (required)

Your Email 2

Additional Information

Birth Date (required)

Gender as shown on travel document Choose One:MaleFemale

Nationality

School Name (if applicable)

Current School Year (if applicable)

Do you speak any languages besides English? (Indicate level of fluency)

There will be times when you will be asked to wear an Alliance for Smiles t-shirt or polo shirt that will identify you as a team member.
Shirt Size (in unisex size)
Choose One:XSSMLXLXXLXXXLOther

Please describe your current health, including any medical conditions we should be aware of.

References

Personal Reference [non-family member; someone who has known you for at least 5 years]

Name

Title

Phone

Email

Notes

Professional Reference

Name

Title

Phone

Email

Notes

Parent or Guardian

Title

First Name (required)

Last Name (required)

Suffix

Relationship to Applicant

Address (required)

Phone

Email

Documentation

The following documents must be submitted before you can be approved:

• - Cover letter and resume - Please include your international and/or medical experience (if any)
• - Short video of yourself - Please tell us why you would be a great asset to our team and how you heard about AfS.

You can upload these items now, at the below link, or you can submit the application now, and upload these items later. (You will receive the link in an email, once you hit SUBMIT below.)

Upload Documents Here: www.dropbox.com/request/vXRTqLbm7NIfQfVL1xKR

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Once you have completed the application and uploaded all files that you wish to, please agree to the terms and hit the SUBMIT button below.

I fully understand that any significant misstatement in or omissions from this application will constitute cause for denial of my application for affiliation with Alliance for Smiles. I hereby affirm that the information I have furnished to Alliance for Smiles on this application and in any accompanying document is true and complete to the best of my knowledge.

Do you agree to the above terms?
YesNo