Ambassador Program

MDS Ambassador Program Application

Thank you for your interest in the International Parkinson and Movement Disorder Society's Ambassador Program. The Ambassador Program is intended to provide an excellent educational opportunity in Movement Disorders education to regions of the world not adequately served by the resources within that region. For more information on the policies, requirements, and structure of the Program, please see the Ambassador Program Policies and Procedures available on the MDS website.

If you would like to invite an MDS Ambassador to present at a neurological meeting in your country, please complete and submit this application to the MDS International Secretariat. Up to two Ambassadors may be requested. Applications will be reviewed by the MDS Education Committee and selected based on the clarity and completeness of the program proposed, how well the program addresses the educational objectives indicated and how effectively the target audience need is explained.

Please complete the following:

Required fields are marked with an *

Applicant Contact Information










Statement of Educational Need

Please summarize the factors that qualify your educational activity for assistance through the Ambassador Program. See Ambassador Program Policies and Procedures for reference.




Proposed Ambassador Program Information





Yes    No



Yes    No

Yes    No

Program Audience Information

* Please identify the target audience of the Ambassador Program you are proposing:

General Neurologists    Primary Care Physicians    Post-Doctoral Fellows    Physicians in Training

Researchers    Nurses/Health Professionals    Other:   

Language and Course Design

Yes    No

Yes    No


Ambassador Information

If you would like to recommend an MDS Member from your region ideally suited to address the educational needs of your proposed program in the preferred language of the target audience, you may do so here. This recommendation will be evaluated among other potential regional candidates. As per the Ambassador Program Polices and Procedures, when more than one faculty is sponsored, not more than one half of sponsored faculty may come from beyond the region in which the program takes place. Suggested Ambassadors must represent different institutions. In an effort to maintain academic diversity in MDS educational programming, it is preferred that no academic or financial relationship exist between the suggested faculty and the host institution. However, it is understood that some exceptions may apply. Any pre-existing relationship should be disclosed below.









Yes    No

Yes    No

Yes    No

If yes, please describe the relationship:





Program Evaluation

As with all of its educational activities, the International Parkinson and Movement Disorder Society will evaluate the effectiveness of this course through a compulsory Participant Evaluation Form. This form measures the knowledge of each participant, both prior to and after the course. Specifically, this evaluation form includes questions that gauge participants' intake of the identified learning objectives, assess general course content, and requests participants to rate each speaker on their presentation. Additionally, this evaluation measures whether the science and medical knowledge advanced by the activity will ultimately enhance the care of patients with Movement Disorders.

The following methods will be employed to measure the outcome(s) of the course:

Participant Evaluation Form
It is the responsibility of the host and MDS faculty to ensure that evaluation forms are completed by course attendees. Following the course, all completed evaluations are to be sent to the MDS International Secretariat for tabulation. In turn, the MDS International Secretariat will provide the evaluation results to the Host, MDS faculty members, as well as MDS and Regional Section Education Committees.

Optional:

  • Pre-test and Post-test. Please note that this method is ideal, however, it will require each faculty member to submit questions for the Pre- and Post- test.
  • Six-month follow-up questionnaire.
Application Templates
File Uploads

Please include the following with your application (*required):



Optional:


MDS Ambassador Program Host Agreement

In person contact provides an invaluable opportunity to discuss collaboration on future Movement Disorder education. As a Host, the MDS Education Committee requests that you meet with the Ambassador(s) to discuss what MDS can do to support Movement Disorder education in the region.

I have read the MDS Ambassador Program Policies and Procedures and acknowledge the following:

* The Host must adhere to the Policies and Procedures that have been outlined with regard to the Ambassador Program that is being proposed.

* The Host/Host organization is responsible for providing comfortable lodging, meals, local transportation, and ensuring the safety of the Ambassador(s) at the cost of the Host, while in the host country.

* MDS agrees to provide airfare for the Ambassador(s) according to the Travel Costs section of the Ambassador Program Policies and Procedures.

* MDS agrees to provide honoraria for the Ambassador(s) in the amount of $1,000 USD for each Ambassador.

* The Host must ensure that a course summary, completed program evaluations and completed Regional Educational Needs Assessment Surveys (where applicable) are submitted to the MDS Secretariat within 60 days of the course date.