International Candidates - Aga Khan University

Aga Khan University
Department of Postgraduate Medical Education
Affix Photograph
Elective Application Form
SECTION `A'
(To be completed by the applicant)
Name: _________________________________________ Country of origin: __________________________
Contact address: __________________________________________________________________________
________________________________________________________________________________________
Tel No: __________ Fax No: e-mail: ___________________________
Name/Address of Medical School: ____________________________________________________________
________________________________________________________________________________________
Year of graduation: _________________
Name & address of institution where presently training: ___________________________________________
________________________________________________________________________________________
Present position in residency/fellowship program: ________________________________________________
Registration/licensure status: Pakistan PMDC [ ] USA [ ] UK [ ]
Year of registration: ____________________
Discipline of elective:
1 st choice: ______________2 nd choice: _____________ 3 rd choice: ______________
Duration of elective: 4 weeks [ ] 6 weeks [ ] 8 weeks [ ]
Proposed dates of elective: From: _________________ To: ____________________
Description of objectives of your proposed elective: _______________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Statement of Visiting Resident/Fellow:
I am aware that if I am accepted for an elective at Aga Khan University, it is my responsibility to arrange
health and malpractice insurance, living expenses and appropriate visa, where applicable.
Signature of applicant: ______________________________________ Date: _______________

SECTION `B'
(To be completed by applicant's institution)
Name of applicant _____________________________________________________
Name of Program: _____________________________________________________
General assessment of academic and clinical ability
Below Average [ ] Average [ ] Above Average [ ] Outstanding [ ]
I certify that the resident/fellow named above is in good standing at this institution. He/She is currently in
______________year of a _______________ year programme. He/She is expected to complete all academic
requirements by________________ (month/year). The applicant will/will not be covered by health and
malpractice insurance. An evaluation report will/will not be required at the end of the electives for which an
evaluation form is/is not provided.
Signature & Date: __________________________________________________
Name & Title:______________________________________________________
__________________________________________________________________
Email:___________________________ Tel. No.____________________
School
Seal
Address: __________________________________________________________
__________________________________________________________________

AGA KHAN UNIVERSITY
Department of Postgraduate Medical Education
Visiting International Resident/Fellow Application
1 The attached form has two sections. Section A is to be completed by the applicant. Section B is to be
completed by the (applicant’s) supervisor/program director. Approximately four weeks duration is the
minimum period for elective rotation in one discipline. The maximum period for the elective is 8
weeks.
2 Eligibility: Electives are aimed towards trainees currently enrolled in a postgraduate program, either
locally and/or outside Pakistan. Electives would comprise of clinical, research and/or educational
activities.
Electives are not recommended for medical graduates waiting for examination results, between jobs or
waiting for visas etc.
3 Section A and B of the application form must be completed and mailed to the address given in section
7. Applications must include CV and letter from the supervisor stating the objectives of the
electives.
Electives trainees would come prepared with objectives, which would be pre-approved for feasibility
by the Supervisor/Program Director of the respective program.
4 Due to delays in the mail and processing time requirement, applications must reach the Department of
Postgraduate Medical Education at least three months prior to the month in which elective rotation is
to commence.
5 Evaluation would be performed by elective trainees and faculty for relevant program.
6 The non-refundable application processing fee for electives placement is US$100 or its equivalent in
Pakistani rupees. The fee is payable to Aga Khan University at the time of joining.
7. All correspondence must be addressed to:
The Associate Dean
Postgraduate Medical Education
Aga Khan University
Stadium Road, P.O. Box 3500
Karachi 74800, Pakistan.
Telephone : (9221) 48594534/48594583
Fax : (9221) 4934294/4932095
E-mail : pgme@aku.edu
8 The University female hostel has air-conditioned, single, furnished room accommodation with
communal washroom and laundry facilities. The candidates pay for their living expenses. The room
rent is *Rs.9500.00 per month and food, which may be purchased from the cafeteria, may cost up to
*Rs.1100.00 per day. Due to shortage of rooms, it is not always possible to get accommodation in the
hostel. Requests for accommodation must accompany the application.
* Subject to change
9. Opportunities for electives are available in the following disciplines at Aga Khan University. Only
those candidates who are in a training program (residency/fellowship) and for which it is a
requirement may apply for clinical attachment. Applicants should list their choices in order of priority
on the attached application form.
Cont’d…pg/2

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1) Pathology & Microbiology 2) Community Health Sciences
3) Medicine:
i) General Medicine ii) Cardiology iii) Gastroenterology iv) Infectious Diseases
v) Neurology vi) Oncology vii) Pulmonology.
4) Surgery:
i) General Surgery ii) Orthopaedics iii) Otolaryngology
iv) Ophthalmology v) Urology vi) Cardiothoracic Surgery
vii) Neurosurgery
5) Anaesthesia 6) Family Medicine 7) Paediatrics
8) Psychiatry 9) Radiology 10) Obstetrics & Gynaecology (females only)
11) Radiation Oncology
Applicants will be notified of the University decision approx. 8 weeks after receipt
of the completed electives form.
Applicants may send their request via mail to the given address, in section 7.
Email contact: pgme@aku.edu
Submission of application does not guarantee confirmation of proposed electives.