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APPLICATION FORM TO JOIN THE INTERNATIONAL STUDENT SURGICAL NETWORK - INCISION
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INSTRUCTIONS:
- Copy this file, replace the word "Template" in the Title with the Country Name
- Please fill all the fields according to the questions. Note that filling every field is required. - Once you fill them please send your application back via email to vpnwg@incisionetwork.org, in order for it to be reviewed.
- Feel free to add other sheets on this document as appendix, in case you want to give more detailed explanations i.e. create a timetable, chart, graphs, your logo etc. Please indicate on those sheets which part of the application form corresponds with the extra information or details you have given. - After the first round of the review process is done, we will get back to you with the respective comments of the reviewers on each part of the application. - According to the comments of the reviewers, you will have the chance to give extra explanations and again sent it back to via email to vpnwg@incisionetwork.org to be notified for the next steps of your membership process.
- The deadline to send the final version of the application form is 2 weeks after the date of receiving it each time.

It is IMPERATIVE that prospective new or reactivating National Working Groups are aware of the process and fully understand all terms, conditions, regulations and guidelines pertaining to NWG activities, given that if this application is approved, signing an MoU referencing all the conditions will be required in order to operate. See excel tab on "Resources & References" for details.
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INSTRUCTIONSTO BE FILLED BY THE APPLICANT ORGANIZATION
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FULL NAME OF THE APPLICANT ORGANIZATION:—
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ABBREVIATION OF THE APPLICANT ORGANIZATION:—
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COUNTRY OF THE APPLICANT ORGANIZATION:—
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NAME, SURNAME AND EMAIL OF THE REPRESENTATIVE (the person who fills the application form):—
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INTRODUCTION:*(write a short explanation as to why setting up a National Working Group (NWG) affiliated to InciSioN would be relevant in your country and your motivation to start an InciSioN chapter in your country)
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VISION:*(write a vision statement outlines what the organization wants to be. It focuses on the future. Please refer to the NWG Toolkit for examples and in-depth advice.)
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MISSION:*(The Mission describes why it is important to achieve the Vision. Please refer to the NWG Toolkit for examples and in-depth advice.)
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EXECUTIVE TEAM:*(Who does your Executive Board/Team consist of, what are their projected or assigned positions, what are their backgrounds and its relevance to the position.)

see. SOP.NWG.2021.12.18.1 section 5.3.3 and NWG MoU section 37.6 for requirements
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FACULTY ADVISOR*(Who will indefinitely, until formally replaced, will your faculty advisor be?)

see. SOP.NWG.2021.12.18.1 section 5.3.3.4 for reference

Must include: Full Name, Affilitation, Contact Email, Written Signed Consent (no specific template)
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ORGANIZATIONAL STRUCTURE: *(in this section, please specify Organizational Structure & Governance details)

see SOP.NWG.2021.12.18.1 and SOP.NWG.2025.04.04.3 for requirements

Internal Governance & Departments – List and describe departments (e.g., Advocacy, Research, Finance, Public Relations); define primary responsibilities; explain roles and hierarchy within the organization.

Membership Model – Indicate whether membership is free or paid; specify membership fees and fund allocation; state plans for transitioning to a paid model (if applicable).

Leadership & Terms – Specify term length for working members and leadership positions; define maximum term limits for leadership roles; outline expected tenure policies.

Voting & Decision-Making Procedures – Describe election processes and voting structures; indicate decision-making mechanisms (e.g., simple majority, two-thirds majority); clarify how governance decisions are made within the NWG.
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PRIORITY AREAS:*(Areas within Global Surgery that are priorities to be addressed within your country.)

see. NWG Toolkit in English, Spanish, French, Arabic for reference

The nature of the National Working Groups is NOT to replicate InciSioN Global activities; it is to have on the ground contact with locals (general public, medical community and government); to bring InciSioN Global's mission to grassroots levels.
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STRATEGIC PLAN (goals, specific objectives, methods, timeline and evaluation):*(How are you going to work for the areas stated above, with specific goals and objectives along with the means by which you will achieve them. You can also state how they will be integrated in the InciSioN global context. Below is a structured format to guide your response:)

Goals – Define the broader vision of your NWG (e.g., Increase Global Surgery awareness in [Country Name]; Expand access to surgical education for students).

Specific Objectives – Break down your goals into concrete, achievable steps (e.g., Raise awareness about Global Surgery among healthcare students; Advocate for Global Surgery policy inclusion in national health agendas). Write them in Order of priority

Methods & Activities – Outline the key actions your NWG will take to achieve the objectives. Examples include:
Education & Awareness – Hosting webinars, panel discussions, or workshops.
Policy & Advocacy – Engaging with medical associations or government stakeholders.
Community Outreach – Collaborating with local hospitals, NGOs, or schools.
Research & Publications – Conducting country-level studies on surgical access.
Social Media & Communication – Managing an online presence to disseminate Global Surgery information.
Resources & Partnerships – Specify the resources needed (funding, expertise, materials) and identify potential partners (universities, government bodies, NGOs, healthcare institutions).

Timeline & Milestones – Provide a structured timeline for key initiatives (e.g., Q1: Social media launch; Q2: First educational event; Q3: Advocacy meeting with policymakers).

Evaluation & Impact Measurement – Define how you will track success, such as:
Quantitative Metrics – Number of events hosted, audience reach, engagement statistics.
Qualitative Metrics – Policy changes influenced, feedback from stakeholders.
Reporting Mechanism – How and when you will assess progress and report outcomes to InciSioN Global.
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SUSTAINABILITY:*(How will you ensure sustainability and growth of your NWG throughout the mandates?)

Include mechanisims you plan to implement to ensure membership growth, engagement, membership count tracking, leadership transitions, election and voting procedures, financial sustainability, maintain social media and organizational activity, measure KPIs.

see Bylaws Aricle 12, SOP.NWG.2025.04.04.3, SOP.ALX.2025.04.04.1 Prerequisites, NWG MoU section 30 for reference
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If selected, please elaborate two activities which you would like to carry out in the first year of your NWG's commencement *(It could be an educational, research or advocacy event, and while it's also mandatory to have of minimum 2 activities each year - it doesn't have to be exactly what you mention here, you can change your mind later. Be specific, include: into, problem statement, methodology/concept, post-activity results (tracking KPIs, etc.))

see Bylaws Article 12, SOP.NWG.2021.12.18.2 section 4.1.3 and NWG MoU section 23-30 for reference
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CONCLUSION:*(A final statement to rest your case, why your proposal should be accepted.)
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