SERF Application Form - The Association for Surgical Education

This is the application for the Surgical Education Research Fellowship (SERF) program. It is designed to equip individuals with the skills and knowledge needed to plan, implement, and report educational research studies.
Course Fee: $3,000.00 plus cost of travel to SERF sessions.
The deadline for applications is January 12, 2024.
Letters of notification regarding course acceptance will be sent by February 3, 2024.
SERF is an experience designed to equip participants to do surgical education research. For individuals interested in improving themselves as teachers or leaders, we recommend the Surgery Education and Leadership Fellowship (SELF). If you wish to apply for SELF please visit https://www.surgicaleducation.com/self.

Name

First Last

Please check one:(Required)

PhD

Other

Email(Required)

Institution(Required)

Institution Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Are you applying as a resident or faculty?(Required)

Resident

Faculty

Please list your PGY(Required)

Enter Faculty Rank:(Required)

Have you ever taken a statistics or research course?(Required)

Yes

Do you have dedicated time for surgical research education?(Required)

Yes

If Yes, how much time?

Supporting Documents

Please merge all files in to ONE pdf and upload as a single document. The following must accompany your application:

1. A current copy of your curriculum vitae.

2.A one to two page statement of interest in surgical education research, which includes:
Reason for interest in SERF Program
Involvement with the ASE
Current activities in surgical education

3. Letter of support from Department Chair or Program Director agreeing to commit to fund the cost of fellowship participation and allow time off for travel to SERF sessions ($3000 tuition plus costs incurred for travel and lodging at the required seminars).

Supporting Materials(Required)

Accepted file types: pdf, Max. file size: 512 MB.

You must be an ASE member to participate in SERF. Please check this box to confirm your membership.(Required)

Yes, I am an ASE member in good standing.

Please check this box to agree to the Course Fee of $3000.00 as well as travel to SERF workshops.(Required)

Course Fee: $3000