International Exchange Program Application...

Thank you for your interest in the International Exchange Program of the American Burn Association.  This program provides financial support for nurses, occupational therapists, physical therapists, and other non-physicians to visit burn centers in the United States to gain added clinical expertise in burn care.  Although primarily directed towards non-physicians, physicians from developing countries will also be considered.

An application form follows, which should be received in the ABA Central Office three months prior to the program.  The total maximum award is $2,000 for incurred expenses.

Please include a brief note with your application, which should:

1. Provide a brief description of the purpose of your visit.
2. State your reason for choosing the specific burn unit.
3. Explain why you feel you should be awarded the grant.

In addition, letters of reference are optional.

If you are awarded an ABA International Exchange Program stipend, it is understood that the grant may not cover all the costs you may incur.  After all incurred expenses have been paid, please submit original receipts and an expense form to the American Burn Association Central Office at 625 North Michigan Avenue, Suite 2550, Chicago, IL 60611.  Also, a brief report of your activity, particularly highlighting the experience gained by this program, should be forwarded along with your request for reimbursement to the Central Office.

Please fill out and submit the following form and submit all additional documentation via email to Charles Yowler, MD, FACS at cyowler@metrohealth.org.

Thank You.


ABA Member:
Name:
Address:
City, State, Zip
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Employer:
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City, State, Zip:
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Profession:
Degree:

Institution:

Supervisor:
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Optional: Names and Addresses of Persons Submitting Letters of Recommendation (if any)
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Name:
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