Name(Required)
Email(Required)
1) Specialty Designation(s): Indicate the specialty area(s) for which you are applying to add the International subspecialty designation. Select all that apply.(Required)

EXPERIENCE

7) Clients supported in the process of crossing international borders for educational purposes: A minimum of 10 clients per primary specialty area in the most recent five years is required. Use this table to list students with whom you have worked, their country of residence (at the time you were working with the student), and the country where they have enrolled:
(Click on the plus or minus icon to add or delete rows)
Student Initials
Age
Country of Residence
Country (or Countries) of Citizenship
Type/Placement/Country of Enrollment
 

TRAINING

VISITS

Upload Evaluative Visits list:
Max. file size: 50 MB.

MENTORSHIPS

APPROACH

Max. file size: 50 MB.

OTHER RELEVANT EXPERIENCE

Questions or any supporting materials should be sent to [email protected].