JAPA Elective Application

Full Name: *

Email Address: *

WhatsApp Number: *

University: *

Students from all Jordanian medical schools are eligible to participate.

University ID Number: *

GPA: *

Please write the GPA either out of 4 or as a percentage.

Step 1 Exam Result: *

Pass
Fail
Not Available

Step 2 Exam Result: *

If it is not available, write "Not Available".

TOEFL or OET Exam Score: *

If it is not available, write "Not Available".

Select up 3 places and month slots for the visiting rotation:

Please make sure that you do not choose the same place more than once

First Place and Month: *

Second Place and Month: *

Third Place and Month: (Optional)

Fourth Place and Month: (Optional)

A 250-word essay explaining why the applicant should be selected for the rotation? *

Statements will be vetted for AI generation.

Please add one attending from your school that can act as a reference if needed and his/her email: *

Do you have any JAPA member who could act as a reference? *

If it is not available, write "Not Available".

Have you volunteered with JAPA before? *

No
Yes

Please list previous volunteering activities with JAPA: *

Layout

How many original researchs do you have as a first author? *

How many original researchs do you have as a co author? *

Layout

How many case reports do you have as a first author? *

How many case reports do you have as a co author? *

Layout

How many conference abstracts do you have as a first author? *

How many conference abstracts do you have as a co author? *

Please list all publications that were previously published (Title, Journal, DOI Number, Link):

Upload your academic transcript (كشف علامات): *

The file must be in .pdf, .png, or .jpg format, with a maximum size of 4MB.

Upload your student verification/proof (إثبات طالب): *

The file must be in .pdf, .png, or .jpg format, with a maximum size of 4MB.

Application Fees - $100.00 *

Check to confirm your agreement to pay a $100 application fee.

Credit Card *

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Name on Card

JAPA Elective Application

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