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I wish to join NECO volunteer faculty
Please fill out the following information regarding your specialty and preferences regarding your interests in joining NECO volunteer faculty - you will be contacted on your NECO email once your form has been received.
* Indicates required question
Name
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Your answer
Qualifications (including awarding Institute and year obtained)
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Your answer
NECO affiliation
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Your answer
NECO email address
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Your answer
Please check the following statements if true
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My association, employment, privilege or practice at any hospital or facility has NEVER been suspended, restricted, terminated, curtailed or not renewed.
My license, certification and/or registration to practice optometry has NEVER been suspended, restricted, terminated, curtailed, not renewed or voluntarily surrendered .
There are NO current challenges to my license, certification and/or registration to practice optometry.
I am NOT currently involved in any professional liability action.
I have NOT been convicted of a felony nor have any pending felony or misdemeanour charges.
I have DO NOT have a history of chemical dependency or substance abuse that might affect my ability to competently practice optometry
I DO NOT have a physical or mental impairment or condition that would make me unable with or without reasonable accommodation to perform the essential functions of an optometrist without a direct threat to the health and safety of others.
Required
As Orbis is a training organization, we are looking for highly experienced volunteers. In this section please elaborate on your teaching experience – which would be relevant to your volunteer work with Orbis. (Please include size of groups, topics, and etc.)
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Your answer
Please check those topics you feel particularly qualified to teach/lecture on during an Orbis program (check all those that apply).
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Refraction
Amblyopia
Strabismus detection and management
Accommodation and convergence disorders detection and management
Soft Contact lenses
Rigid contact lenses including Gas Permeable and Scleral
Orthokeratology
Public Health
Myopia Control
Paediatric Low Vision management
Adult Low Vision management
Post-operative care
Required
Are you interested in running an overseas training program and/or joining the telehealth team on Cybersight?
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Overseas Hospital Training Program
Cybersight Telehealth Mentor
Both
Cybersight telehealth mentors may be asked to contribute to online learning in several ways. Would you be able to (check all those that apply)
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Consult on patient cases?
Present a webinar?
Write online content for the optometry library of resources?
Contribute instructional videos on clinical techniques?
Required
Overseas volunteers may be required to teach in different training settings. Would you be able to (check all those that apply)
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Lecture?
Run practical sessions?
Clinical teaching?
Required
Please tell us briefly why you would like to participate with Orbis and if you have any experience working in developing countries.
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Your answer
Months NOT available to volunteer (check all those that apply)
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August 2018
September 2018
October 2018
November 2018
December 2018
January 2019
February 2019
March 2019
April 2019
May 2019
June 2019
July 2019
Other:
Required
How much notice do you require?
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Less than 3 months
3-6 months
6-9 months
9-12 months
12 + months
Required
Languages spoken fluently?
English
French
Spanish
Portuguese
Arabic
Mandarin
Cantonese
Swahili
Other:
Languages spoken conversationally?
English
French
Spanish
Portuguese
Arabic
Mandarin
Cantonese
Swahili
Other:
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