2025 Clinician Scholars Career Development Program

Name*

First NameLast Name

Credentials (MD, PhD, MBA, etc.)

E-mail*

Phone Number*

Area CodePhone Number

What is your racial/ethnic identity?

American Indian or Alaska Native: A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.Asian: A person having origins in any of the original peoples of the Far East, Southeast Asia, or Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Phillippine Islands, Thailand, and Vietnam.Black or African American: A person having origins in any of the black racial groups of Africa.Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.Native Hawaiian or other Pacific Islander: A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.White: A person having origins in any of the original peoples of Europe.Middle Eastern or North African: A person having origins in any of the original peoples of the Middle East or North Africa, including, Lebanese, Iranian, Egyptian, Syrian, Iraqi, and Israeli.Non-US NativePrefer not to answer

What is your gender identity?

AOFAS Member Type*

Surgeon in Training - ResidentSurgeon in Training - Surgeon in FellowshipCandidate - Jr Faculty through Year 3Active - Jr Faculty through Year 3

PGY (if applicable)

2345

Job Title*

Current Employer/Institution Name*

Employer's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

1) Most Recent*

2)

3)

4)

5)

1) Most recent*

2)

3)

4)

5)

6)

If you have Research Experience beyond the first 6 above, please attach a pdf document listing the project title, research site/institution, year, and project funding of each

Browse Files

0/600

Upload CV pdf here*

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Your Letter of Support must have the following information:

How long you have known your Department Chair, Division Head, or Research Supervisor?
Your job/tasks/role on the research team
Why the person recommends you for the Clinician Scholars Career Development Program
Can you be supported and supervised in research, and do you have the tools and capability within the institution to succeed?

Upload Letter of Support pdf here*

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Name*

First NameLast Name

Date*

Date

Signature*

2025 Clinician Scholars Career Development Program (CSCDP)

I. THE APPLICANT

II. EDUCATION

III. RELEVANT RESEARCH ACTIVITY

IV. PERSONAL STATEMENT

V. CAREER GOALS

VI. ORTHOPAEDIC AREAS OF INTEREST

VII. MEMBERSHIP IN ORTHOPAEDIC SPECIALTY SOCIETIES

VIII. CV and LETTER OF SUPPORT

IX. APPLICATION CERTIFICATION