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).