2024 - 2025 Resident Rural Elective Grant Request Form

Resident Name *

Email Address for E-Transfer *

Elective Zone *

Elective Zone

North
Central
South
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City *

Cell No. *

Preceptor Name *

Start Date of Elective *

End Date of Elective *

Was Program Director Approval Email Sent to AOS? *

Yes

No

Grant Amount *

$

Resident Signature *

Clear

Resident Signature

CRITERIA GUIDELINES - Effective October 1, 2024

The grant is $2,000 per four-week Orthopaedic Resident Rural Elective in the North, Central, and South Zones.
AOS needs preceptor and program director approval via email before the elective, including the resident's name and elective dates.
Payment will be processed after the elective upon receipt of this form with the resident's signature.

Disclaimer Statement

I hereby acknowledge that upon submitting this Grant request to AOS, it is my responsibility to declare it as income on my income tax return.

The Alberta Orthopaedic Society bears no liability and assumes no responsibility for any Orthopaedic residents who do not claim this as income.

Please note that grant availability will be reassessed annually, based on the level of funds available.

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