Ophthalmology - ROP Education Grant Application

Ophthalmology - ROP Education Grant Application

Institution Applying

 

Applicants

3 applicants are required. There should be one of each of the following:
1. Ophthalmologist experienced in indirect ophthalmoscopy in infants
2. A fellowship trained and pediatric “oriented” ophthalmologist or neonatologist
3. Administrative Support/Nurse/Technical Staff
4. 4th team member is optional

Ophthalmologist

 

answer must be an email address

 

 

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Pediatric Ophthalmologist or Neonatologist

 

answer must be an email address

 

 

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Administrative Support/Nurse/Technical Staff

 

 

answer must be an email address

 

 

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Optional Applicant

 

answer must be an email address

 

 

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answer must be an email address

 

 

Present status of ROP screening in the unit

answer must be numeric

 

required31. Screening criteria (select all that apply)

required31. Screening criteria (select all that apply)

required32. Breakdown type of treatment (select all that apply)

required32. Breakdown type of treatment (select all that apply)

Information on neonatal unit

 

required35. Use Oxygen

required35. Use Oxygen

Information on teaching

required37. Ophthalmology training programs at your institution (select all that apply)

required37. Ophthalmology training programs at your institution (select all that apply)

 

General

 

Please upload two (2) letters of support

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