AUA/AFU Visiting Scholar Program Form

France

Enter the information requested below, attach the three listed documents, verify and "sign" where indicated, and click Submit to complete this application.

* Denotes required fields.

Personal Data

First Name: *

Middle Name:

Last Name: *

Birth Date (Ex: XX/XX/19XX): *

Email: *

Home Mailing Address

Street: *

City: *

State/Province: *

Country: *

Zip/Postal Code: *

Home Phone: *

Work Mailing Address

Street: *

City: *

State/Province:

Country: *

Zip/Postal Code: *

Work Phone: *

Work Fax:

File Attachments

Upload any supporting files below. (Note: The filename should not should contain any punctuation, special or foreign characters.)

If you have any problems with submitting your documents, please contact international@auanet.org.

Allowed file types: PDF, PNG, JPG, JPEG, GIF, DOCX, DOC

The maximum total file size for all documents should be less than 4MB.Total file size submissions exceeding 4MB may result in an error and delays with processing your application.

(El tamaño máximo de archivo total para todos los documentos debe ser inferior a 4 MB. El total de envíos de archivos que superen los 4 MB puede ocasionar un error y demoras en el procesamiento de la aplicación.)

Curriculum Vitae *:

Personal Statement *:

Support Letter (Must be from a current department chair, signed and on letterhead.) *:

How did you hear about this program?:

Other:

I verify that the information in these application materials is correct to the best of my knowledge. If selected, I will participate in the AUA/AFU Academic Exchange Program.

Signature: *

AUA/AFU Visiting Scholar Program Form

France

Personal Data

Home Mailing Address

Work Mailing Address

File Attachments

American Urological Association

About AUA

Quick Links