International Gynecologic Oncology Observership Application

The Division of Gynecologic Oncology at Massachusetts General Hospital offers a three-week virtual observership to provide physicians and physicians-in-training from around the world the opportunity to expand their knowledge and deepen their expertise in caring for women with gynecologic cancers.

To apply for the observership, please fill out and submit the form below. All observers will be required to sign a confidentiality agreement and pass a short written test prior to acceptance into the program.

What rotation is your first choice for the observership?

What rotation is your second choice for the observership?

Note: Please specify both the two-month period and the year. Available rotations are January-February, March-April, May-June, July-August, September-October and November-December.

Last (Family) Name

First (Personal) Name

Middle Name

Other names used

Gender

Date of birth

mm/dd/yyyy

Place of birth (city, country)

Primary language

Secondary languages

Street address

City

State

Zip code

Country

How long at this address

Primary phone number

Alternate phone number

Email address

Alternate email address

Current employer

Employer address

Employer phone number

Your current title

Department

Current supervisor's name

Supervisor's phone number

Supervisor's email address

Date of hire

mm/dd/yyyy

Name of medical school

Medical school address

Medical school phone number (please include country and city code)

Medical school fax number (please include country and city code)

Degree earned (ex: MD, MBBS, PhD)

Graduation date

mm/dd/yyyy

I attest that I am fluent in spoken and written English

YesNo

The Mass General Difference

Conditions & Treatments

Patients & Visitors

Research & Innovation

Obstetrics & Gynecology

International Gynecologic Oncology Observership Application