International Student Application Form

Application for Admission to PhacoMentors courses – We thank you for starting your journey with PhacoMentors. All fields in this form are compulsory. If some are not applicable, please do type in as Not Applicable.

Instructions for filling in the Application Form

Step 1: Fill in the details

Enter all relevant details carefully. Data Once Submitted can not be changed. So please take a look before final Submission. The Form has 4 sections. ALL SECTIONS must be completed before pressing the Apply Button.

Step 2: Confirmation of Submission

Press the Apply Button
After Successful Submission of Application Form, you will get a confirmation message on the screen.

    Section I - PERSONAL INFORMATION


    Your Email

    Level of English (Spoken)

    1 - Didn't understand English / 5 - Completely understand English

    Level of English (Written)

    1 - Can't write in English / 5 - Natural written English

    Gender
    MaleFemaleOther

    Marital Status
    SingleMarriedDivorcedOther

    Do you suffer from any medical condition/disability that may affect your studies?
    If yes, please specify from the following

    HearingMobilityVisual (Stereopsis)MedicalOtherNONE

    How did you hear about us?

    Print / NewspaperWord of MouthGoogle or other Search enginesSocial NetworksWebinarsOther

    Section II - EDUCATIONAL and PROFESSIONAL BACKGROUND

    Highest Level of Education Achieved

    Medicine School - Year of Graduation

    Residency - Year of Graduation

    Fellowship - Year of Graduation

    Have you received any recognition, citation, or awards during academic formation or professional life?

    Please describe them.

    Years working as an ophthalmologist

    Number of Phaco Cataract Surgery performed

    Number of MSICs Cataract Surgery performed

    Number of EECC Cataract Surgery performed

    Which of the courses are you interested in:

    Phaco Basic SkillsPhaco Advanced SkillsComplex Cases / Complication managementPremium IOLs / IOLs Calculation

    Section III - SKILLS and STRENGHTS

    How good you are at Reading Scientific Papers

    1 - Bad / 5 - Good

    How good you are at Writing Scientific Papers

    1 - Bad / 5 - Good

    How good you are at Interpreting Statistics

    1 - Bad / 5 - Good

    How good you are at Critical Thinking

    1 - Bad / 5 - Good

    How good you are at Meeting Deadlines

    1 - Bad / 5 - Good

    How good you are at Manual Dexterity

    1 - Bad / 5 - Good

    How good you are at Teamwork

    1 - Bad / 5 - Good

    How good you are at Public Speaking

    1 - Bad / 5 - Good

    How good you are at Managing Time

    1 - Bad / 5 - Good

    How good you are at Problem Solving

    1 - Bad / 5 - Good

    How good you are at Thinking Outside the Box

    1 - Bad / 5 - Good

    SECTION IV - FINAL DECLARATION

    By hitting the "APPLY" button, I hereby declare that I have provided accurate information in this form myself (the student applicant).