SIR International Visiting Professor Program Application for Host Society

| Resume a previously saved form
Resume Later

In order to be able to resume this form later, please enter your email and choose a password.

Page 1

Society of Interventional Radiology

Instructions for application.

National, regional or local radiology societies, universities, or hospitals in, or that primarily serve developing countries are invited to apply to host an international visiting professor (IVP) team.  The host institution will select and organize visits to hospitals that have active interventional radiology training programs with the need and potential for educational enrichment from an international visiting professor team. If desired, the IVP team will also lecture at the host's national or regional radiology society meeting.

The host institution is expected to:
  • Provide complimentary hotel accommodations and most meals to the international visiting professor for the duration of their visit.
  • Appoint a contact who is fluent in English and able to communicate program, schedule, and hospitality arrangements with the IVP and the SIR staff contact.
  • Complete an evaluation of the visiting professor and the program within four weeks of the IVP visit.

The host hospital is expected to:

  • Appoint a contact who is fluent in English and able to communicate and act as a liaison to the visiting professor and SIR staff through the duration of the program.
  • Complete an evaluation of the visiting professor and the program within four weeks of the IVP visit.

Application requirements:


Applications must be completed and submitted jointly by the national, regional, or local radiology society, university or host hospital. Along with your application please include a proposed one to two week schedule for an IVP visit.


Submitting your application and supporting documentation:


Application and all supporting materials should be submitted electronically to Shams Iqbal drshams241@gmail.com (If the materials cannot be submitted electronically, please mail a hard copy to Society of Interventional Radiology, 3975 Fair Ridge Drive, Ste 400 North, Fairfax, Virginia, 22033, USA.


Learn more about this program, including eligibility and requirements at this link www.sirweb.org/giveback.  For questions, contact the SIR Giveback team at 703-460-5574 or email Shams Iqbal drshams241@gmail.com

 PLEASE TYPE OR PRINT. IF COMPLETING THIS ELECTRONICALLY, USE ADOBE READER , AVAILABLE FREE ONLINE.
1.  Host Institution Information:

















You will have a chance to review your responses on the next screen before the application is submitted.

Page 2

Educational Needs:
Should your institution be selected to host a visiting professor team, the SIR committee will appoint expert professor's based on the educational needs identified in your application. Please work with the proposed hospital institution(s) listed in your application to identify the educational needs that the visiting professor will address during their visit. Please follow the directions below:
  • Within the subspecialty list below, rank the top three subspecialty areas you would like the visiting professor to cover.
  • To further define the educational need(s) of your learners, check the modalities that you would like the visiting professor to cover (for each of your ranked subspecialties). (this step is optional)
                                                                 Procedure Specialty


Page 3

Housing and Transportation:






For further information, please contact SIR Giveback team at (703) 460-5574 or email Shams Iqbal drshams241@gmail.com
Captcha

Please enter the characters you see in this picture:

Visual CAPTCHA

This helps prevent automated form submissions. If you are not sure what the characters are, make your best guess. You will have another try in the next screen.
Can't see the image? Click here for an audible version in English.