2023 Humanitarian Outreach Project Volunteer Application

The Humanitarian Outreach Project is open to AOFAS Active Members, Candidate Members, and International Members. Surgeons volunteer their time and pay for their own travel to the overseas countries. In-country expenses for food, lodging, travel, and logistics are covered by the Orthopaedic Foot & Ankle Foundation.

Applications are open for two foot and ankle orthopaedic surgeons for an Overseas Outreach Trip to Kenya from Monday, October 9 to Friday, October 13, 2023. Participants would purchase their own airfare to travel the weekend before and after this week.

Deadline to submit your application is Friday, June 16, 2023 by 5:00 PM Central time USA.
2023 Humanitarian Outreach Project Volunteer Application

KENYA - Monday, October 9 to Friday, October 13, 2023
Are you an AOFAS Active, Candidate, or International member?*

Yes If yes, you may continue with this application.No
Name

First NameLast Name
Preferred Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Work Phone
Home Phone
Cell Phone
Preferred E-mail address
example@example.com
Date of Birth

MonthDayYear
Date
Name of Emergency Contact
Relationship
Emergency Contact's Phone
Total Years in Practice?
What percentage of your practice is foot and ankle?
How many years of experience do you have in adult foot & ankle orthopaedics?
Number of years
How many years of experience do you have in pediatric foot & ankle orthopaedics?
Number of years
Where did you complete your orthopaedic residency?
Duration of orthopaedic residency (number of years)
Did you complete a Foot & Ankle orthopaedic fellowship?

NoYes If yes, provide:
Program Name
Duration
Name of Program Director
Please describe any other training in foot & ankle orthopaedics:
During your time in the host country, you may be in remote areas away from major hospital care. What health considerations do you have that may put you at risk in such a location?
List any allergies you have
What is your proficiency in the English language?

Fluent, native speakerFluent, second anguageBasicConversational
Do you know any other AOFAS member(s) who have participated on an AOFAS humanitarian trip in prior years?

YesNo
If yes, who?
Have you previously participated in humanitarian mission trip(s) to a foreign country with any other organizations?

YesNo
If yes, please describe.
Please list at least one lecture on a surgical technique that you could deliver which would be relevant to our Kenyan colleagues (fracture management, treatment of spastic cerebral palsy lower extremity, infection management, etc.)
List all countries to which you have traveled in the last five years and the approximate time spent in each (include military experience)
What attributes and/or skills do you have that would distinguish you as a candidate for this trip?
What do you expect to gain from your experience with the AOFAS Overseas Outreach Project?
Contributions to support this project may be made to the Orthopaedic Foot & Ankle Foundation: https://www.aofas.org/foundation/support-the-foundation

Questions? Contact: The Orthopaedic Foot & Ankle Foundation, 9400 W. Higgins Road, Suite 220 ● Rosemont, IL 60018 USA Phone 1-800-235-4855 or 1-847-698-4654 E-mail foundation@aofas.org
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