/ Pan-African Academy of Christian Surgeons (PAACS)
P. O. Box 9906
Fayetteville, NC 28311-9906

PAACS Residency Application (Malawi)

Instructions: Move from blank to blank using the tab key. If there is a box, type in “x” to signify the correct answer. If there is a rectangle, then type your answer in that rectangle.

Please note:If you are over 35 years old, your chances of being accepted into a PAACS program will be considerably less than for younger candidates, but you may complete the process of applying to PAACS if you wish. If you are over 40 years old, we regret that we will not be able to process your application.

Section I: General Information

Surname Date of Birth:

First Name(Applicants must be age 35 or younger)

Other Names

Name you go by: Gender/Sex Male Female
Nationality: Spouse’s Names:
Spouse’s Date of Birth: Date of Marriage:
List the names, date of birth, and ages of your own children under the age of 18. If the children were not born to you or your spouse, please check if legally adopted.

1. Date of Birth Age Adopted

2. Date of Birth Age Adopted

3. Date of Birth Age Adopted

4. Date of Birth Age Adopted

5. Date of Birth Age Adopted

Your Current Mailing Address:
One or several phone numbers where we can reach you:

Cell Phone Number (include country code)

Your current e-mail address:

Section II: ACADEMIC HISTORY: Please list, in order, the schools you have attended:

Dates School Name and AddressDiploma Received

1. From to

2. From to

3. From to

4. From to

5. From to

6. From to

7. From to

Describe any medical training you received after graduating from medical school:

DatesHospital Name and Address Certification

1. From to

2. From to

3. From to

4. From to

List the places you have worked since graduation:

Dates (give both month & year mm/yy) / Name and Address / Position Held
1. / to
2. / to
3. / to
4. / to

Do you have any obligations to any organization (hospital, a government, church, military, mission agency, etc.) that you are required to complete either currently or at some date in the future? Yes No. If you answered yes, please provide a description of any obligation. .

On a separate page, please answer the following questions:

  1. Why did you choose to go into medicine as a career?
  2. Why do you want to become a surgeon?
  3. What attributes and abilities do you have that you believe will help you in pursuing surgery as a career?
  4. How are you prepared to handle the rigors of five years of surgery residency training?
  5. What do you want to do after you finish General Surgery training?

Section III: Spiritual

SPIRITUAL DECLARATION - THIS DOCUMENT GIVING YOUR TESTIMONY IS VERY IMPORTANT TO YOUR ACCEPTANCE!

On a separate sheet of paper, write a 1,000-word testimony of how you came to faith in Jesus Christ. Explain how this has changed your life from that moment until the present. Please take your time and do it well. It should be typed and detailed enough to take up at least three full pages. It should include clear answers to the following questions:

  1. What was your life like before you met Jesus? (Please include relationships with members of the opposite sex that produced children or marriages that ended in divorce.)
  2. How did you come to realize that you needed Jesus?
  3. How did you then commit your life to Jesus?
  4. What does it mean to you to “repent of your sin”?
  5. What difference has your commitment to Jesus made in your lifestyle?
  6. How do you see your surgery as a ministry?
  7. What has God taught you from:

(a)Failure?

(b)Success?

(c)Lack of money?

(d)Pain, illness, suffering, sorrow or depression?

(e)Disappointment?

What is the name and location of the church that you currently attend?

Provide your pastor’s name, mailing address, e-mail address, & telephone number:

Pastor’s Name:E-mail:

Mailing address: Telephone:

Section IV: References

Provide the names and e-mail addresses and/or telephone numbers of two people that we can contact who can tell us something about you and state their relationship to you (supervisor, deacon, friend, professional colleague, etc.):

Name RelationshipE-mail AddressPhone Number

1.

2.

Answer “Yes” or “No” to the following question:

Yes No I have asked my church, denomination, or hospital to support me during my surgical training. Their response was .

Section V: YOUR ACCEPTANCE OF THE FOLLOWING PAACS POLICIES

I fully understand that by signing this application, I agree to the following policies of PAACS Training Programs:

  1. Each year residents must prepare and give monthly formal oral presentations or written case reports.
  2. Residents will be required to first-assist or perform a minimum of 200 operations a year and will fill out and turn in to their program director a yearly record of operations.
  3. Residents will take a comprehensive examination in general surgery each year that is prepared by the PAACS. If a resident does not pass, the program director is not obliged to advance him to the next level of training. If a program director does not believe that a resident’s effort or skill justifies his repeating the year, or if a program director finds that a resident is insubordinate or irresponsible, he is under no obligation to keep the resident in the training program.
  4. Applicants are being accepted only into the first part (MCS) of training as defined by either WACS or COSECSA. Near the end of the MCS period, the residents will be re-evaluated for possible acceptance into the subsequent FCS (Fellowship) level training. There are no implicit or explicit guarantees that all residents will be trained to the FCS level.
  5. A resident will receive PAACS certification only if he completes all of the requirements during all five years of the training program. If he drops out after completing only part of the surgical training program or does not pass his final exams, his program director will give him a certificate of training from PAACS stating only that he completed a certain number of years of formal surgical training.
  6. Residents who are approved for sponsorship through PAACS will receive a monthly educational stipend (which will serve as their salary). This amount (which varies by program site) will be disclosed to you once it is decided where a training opportunity exists. After completion of their surgery training, the sponsored resident will be asked to serve as a surgeon in an underserved area of Africa for a period of one year of service for each year of sponsorship. The resident and PAACS will work together to identify a suitable hospital where time of repayment owed by the resident to PAACS will be served.
  7. If the resident is sponsored by some other agency other than PAACS, he must agree to accept the same level of reimbursement as received by the other PAACS residents at that same level of training.
  8. Residents accepted to train with PAACS may not be government employees. If they were employed by the government prior to their acceptance they must include with their application written proof that they have resigned and are no longer considered by their government to be an employee of the State.
  9. Residents are not permitted to receive direct payment for their services from patients or from the hospital where they train. The hospital where a resident trains will be responsible to provide the resident with furnished housing, or with the financial equivalent.
  10. Residents understand and agree to comply with the PAACS policy on spousal separation (You cannot live apart from your spouse for a period of time exceeding one year during the 5 year program.
  11. Failure to provide accurate and complete information or failing to disclose pertinent information may lead to dismissal from the program or a failure to be accepted.
  12. Residents are responsible for moving their family both to and from the place of training.
  13. Residents may be required to maintain active licensure in both their home country and their country of training.
  14. Each PAACS resident must accept in full the following PAACS statement of belief:

PAACS STATEMENT OF BELIEF

  • We believe that the Bible, in its entirety, is the only inspired, inerrant Word of God.
  • We believe that there is one God eternally existent in three persons: the Father, the Son and the Holy Spirit.
  • We believe that Jesus Christ is God the Son, born of a virgin, fully God and fully Man, who willingly died on the cross for the sins of Man and rose from the dead to sit at the right hand of the Father.
  • We believe that all men are by their very nature sinful and that the forgiveness of sin and the gift of eternal life come only through repentance and faith in Jesus Christ.
  • We believe in the ministry of the Holy Spirit who indwells those who are born again by the Spirit of God, and enables believers to live a godly life.
  • We believe in the personal return of Jesus Christ to reign in power and glory on the earth. He will judge the saved and the lost – the saved will receive eternal life and the lost will receive everlasting punishment.
  • We believe in the unity of all believers who love, worship and obey Jesus Christ as the Son of God.
  • We believe that it is the duty of all who love and obey Jesus Christ to proclaim his gospel to their neighbors and to the world and to respond with compassion to the suffering around them in the ways that Jesus did, regardless of race, religion, nationality, or social status.

Please accept my application to become a surgery resident in the PAACS Training Program in General Surgery. I hereby certify that I am in good health and HIV-negative. I agree to all the terms and conditions stated herein and hereby certify that all information I have provided is correct to the best of my knowledge and belief.

Your Printed Name:

Date Application completed:

ADDITIONAL REQUIREMENTS

Your application must include the following to be complete:

  • A copy of your birth certificate (if you have one, if you do not, provide a copy of your government issued photo ID)
  • A copy of your current passport
  • A copy of your marriage license (if married)
  • A copy of the PAACS Health Certificate or its equivalent
  • A copy of your medical diploma
  • A copy of your medical school transcript (either individually by year or cumulative)
  • A copy of your results for national examinations (check the box if your country does not participate in such exams )
  • A copy of your medical license (Ordre des Medecins)
  • A completed PAACS recommendation form from your church pastor or board
  • A completed PAACS recommendation form from a Christian medical colleague
  • A color photograph (scanned, attached to an e-mail or mailed)
  • A letter of reference from your present supervisor

Kindly Note: You are responsible to see that all these forms and documents are submitted by the deadline.

You are responsible for documents not in English to have an authorized translation.

Once the above information is completed, if you are selected to continue, you will be notified by e-mail and you will be asked to complete the following items at that time:

  • A telephone interview
  • A face to face interview may be required

Please e-mail this application and scans of all the requested documents to:

Pan-African Academy of Christian Surgeons (PAACS)

P. O. Box 9906

Fayetteville, NC 28311-9906

For Applicant’s Use Only

Please keep a list of dates as you e-mail documents to PAACS. The deadline for having all of your information in to PAACS is September 15. You are strongly encouraged not to wait until the last minute to get this information to us as it often takes several months for you to obtain it!

Send the completed list to . This will assist both you and PAACS in making sure that all documents are received by the appropriate deadline.

Document / Date e-mailed to PAACS
Birth Certificate
Passport
Marriage License
PAACS Health Certificate
Medical Diploma
Transcript from Medical School
Results of National Examinations
Medical License or Ordre des Medecins
Recommendation Form from Pastor
Recommendation Form from Colleague
Color Photo
Essay (when assigned)
Letter from Applicant’s Supervisor

June 2, 2016