AAO Education Request Form

Page One

From time to time, the American Academy of Ophthalmology is able to provide the Basic and Clinical Science Course (BCSC), a complete curriculum in ophthalmology, for free to ophthalmology training programs (residencies) in low- and lower-middle income countries. If the training program at your institution would be interested in receiving a BCSC set, provide the information requested below. (Beginning on the second page, you will be able to Save your information and return at a later date.)

Kindly note that due to limited supplies, we are only able to send a new set to a given program every four to five years. Shipments are not guaranteed.

Email outreach@aao.org for more information.

Please provide complete and current contact information.

Name of Institution *This question is required.

Shipping address *This question is required.

City/State *This question is required.

Postal Code

Country *This question is required.

Telephone number *This question is required.

Program Director (First and Last Name) *This question is required.

Program Director Email Address *This question is required.

Program Contact (First and Last Name) *This question is required.

Program Contact Email Address *This question is required.

Is there an ophthalmology residency training program at your institution? *This question is required.