Your Employer’s Name: (institution, hospital, or university)
Work Fax Number: (country code - city code - number)
Describe Your Current Position and Job Responsibilities:
Describe Your Experience in Health Care:
(examples: nursing, pulmonary medicine, anesthesia, physiotherapy, critical/intensive care, academics, additional training or experience, etc.)
What professional groups (physicians, nurses, physiotherapists, or others) currently perform respiratory care procedures in your hospitals and other institutions? This would include procedures such as airway care, aerosol therapy, oxygen therapy, mechanical ventilation, diagnostic testing, etc.
Please explain how health care is administered and funded in your country:
Are you a member of the AARC and/or a respiratory care society within or outside your country?
Do you have a current passport and are you able to acquire a visa to travel to the United States?
If no, please provide an explanation:
Have you previously traveled in the United States for professional training or other professional reason?
If yes, please explain:
Have you attended an international respiratory, thoracic, or lung conference outside your country?
If yes, please list the conferences you have attended:
Have you previously applied to be an International Fellow?
Will you need an official letter of invitation if selected to be International Fellow?
What are your expectations of your AARC Fellowship if you are chosen?
Upon completion of your Fellowship what are your specific plans and goals to develop and improve respiratory care in your country?
What resources do you have (such as agencies, hospitals, universities, ministry of health, or personnel) that can help you achieve your plans and goals to improve respiratory care?
Will you agree to do a written report and respond to surveys from the committee at 6 months and at 12 months after your fellowship?
How did you learn about the AARC International Fellowship?
Attach your curriculum vitae (résumé/biographical data) to include a list of any publications you have completed, a letter of recommendation from your institution’s director, two general letters of recommendation, and a digital photograph of yourself:
First Recommendation Letter:
Second Recommendation Letter: