Application

Account Creation / Start Application Your Name:

(May be the Fellowship Director or administrative staff, but should be the primary system user who will work with this program application.)

Fellowship Director's Email Address

This will be the UserID for this account and address of record for future communications. It MUST match the Fellowship Director's email address entered in the application and the email address used as the electronic signature.

Requested Password

Show password

Password Requirements

Maximum length of 16 and minimum length of 12 characters including at least:
One (1) upper case letter
One (1) lower case letter
One (1) digit (0-9)
One (1) of the following symbols ! @ # $ % ^ & * ( ) _

Confirm Requested Password

Must match the requested password entered above.

Program Information

An entry for all fields is required.

Parent Institution

Affiliated Medical School or Government Training Institution

Number of Fellowship Positions Requested

Please enter the total number of positions you are applying for and would like to have approved as AUPO FCC Compliant position(s)

TOTAL Number of Program Faculty

Please enter the total number of ALL faculty who will work directly with the AUPO FCC Compliant positions in your fellowship program.
Faculty includes:

Fellowship Program Director
Full Time
Part Time, Compensated
Part Time, Voluntary

Department Chair

Is your program affiliated with an ophthalmology residency / will you have a letter of support from the Department Chair?

Yes
No

Association of University Professors of Ophthalmology
Fellowship Compliance Committee

655 Beach Street San Francisco, California 94109
Telephone: (415) 561-8537 | Fax: (415) 561-8531 | Email us