The Pan-African Academy of Christian Surgeons
P.O. Box 9906, Fayetteville, N.C. 28311-9906, U.S.A.
APPLICATION AND AGREEMENT
FOR PAACS SUPPORT DURING TRAINING
Your name(s):
(Surname, Father’s Name, Grandfather’s name if Ethiopian; Surname, First name and other names if not Ethiopian)
Current address:
Name and address of your church/denomination:
E-mail address for your church/denomination: Contact name:
E-mail:
Your marital status:
married
married with dependent children
single
If dependent children (either naturally born to you or legally adopted), list their names and ages:
1.
Age
2.
Age
3.
Age
4.
Age
Spiritual Information
SPIRITUAL DECLARATION - THIS DOCUMENT GIVING YOUR TESTIMONY IS VERY IMPORTANT TO YOUR
ACCEPTANCE OF A PAACS SCHOLARSHIP!
On a separate sheet of paper, write a 1,000-word testimony of how you came to faith in Jesus Christ. Explain how
this has changed your life from that moment until the present. Please take your time and do it well. It should be
typed and detailed enough to take up at least three full pages. It should include clear answers to the following
questions:
1.
2.
3.
4.
5.
6.
7.
What was your life like before you met Jesus? (Please include relationships with members of the opposite
sex that produced children or marriages that ended in divorce.)
How did you come to realize that you needed Jesus?
How did you then commit your life to Jesus?
What does it mean to you to “repent of your sin”?
What difference has your commitment to Jesus made in your lifestyle?
How do you see your surgery as a ministry?
What has God taught you from:
(a) Failure?
(b) Success?
(c) Lack of money?
(d) Pain, illness, suffering, sorrow or depression?
(e) Disappointment?
PAACS Stipend Application – Revised February 11, 2013 Page 1 of 4
What is the name and location of the church that you currently attend?
Provide your pastor’s name, mailing address, e-mail address, & telephone number:
Name:
E-mail:
Mailing address:
Telephone:
References
Provide the names and e-mail addresses and/or telephone numbers of two people that we can contact who can
tell us something about you and your spiritual life. State their relationship to you (pastor, deacon, friend,
professional colleague, etc.) Please have each reference complete the PAACS Ethiopia Spiritual Recommendation
form and return it with this application:
Name
Relationship
E-mail Address
Phone Number
1.
2.
Agreement Attestation
Please answer the following questions with a “yes” or “no” answer:
Yes
No
I have asked my church/denomination to support me during my surgical training.
My church’s response was:
Yes
No
I have a definite interest to returning to a specific hospital after training. Please list the name
and address.
Yes
No
This hospital is a mission hospital
Yes
No
Is there a mission organization affiliated with your church?
If yes, have you contacted them to see if they would be willing to support you?
The mission organization’s response was:
Yes
Yes
No
I am asking the PAACS to provide me with a stipend for my support during
years
3 years 4 years 5 years of surgical training.
Yes
No
I intend to make general surgery my specialty.
Yes
No
I understand that even if I receive a PAACS stipend for my support, I, my church, or my
sponsor will have to pay travel expenses for me and my family to the training hospital where
I am accepted, and travel expenses for me and my family to return home after I complete my
training.
Yes
No
I understand that I, my church, or my sponsor will have to pay the cost of obtaining my entry
visa and permanent visa in the country where I will be in training.
PAACS Stipend Application – Revised February 11, 2013 Page 2 of 4
1 year
No
2
Yes
No
I understand that if I am given a PAACS support stipend for my support during the five years
of my training in general surgery, I must work at a PAACS-approved hospital for five years
after my graduation.
If I do not fulfill my obligation to PAACS, I agree to repay all that I received within 30 days.
I understand that I may not leave my work at a PAACS-approved hospital for other training of
any kind until I have fulfilled my obligation to PAACS, unless such training meets the following
requirements:
1. It significantly advances PAACS objectives or will directly benefit a PAACS hospital
long-term after the training is completed.
2. It is approved in writing by the PAACS leadership.
Yes
No
I understand that a PAACS support stipend is not a salary for my work and is only designed to
provide a reasonable standard of living for food, clothing, utilities, local school expenses if I
have children, and other personal expenses. My role is general defined as being a student
and not an employee. I also understand that the amount of the PAACS support stipend will
be paid in local currency at a flat rate per month, the amount to be determined at the
beginning of PAACS fiscal year, which runs from July to June.
Yes
No
I understand that my housing, including all necessary appliances and furnishings, will be
provided for me by the training hospital where I am accepted and not by the PAACS.
Trainees at some programs re expected to pay the prevailing subsidized rate for housing and
utilities.
Yes
No
If approved for a PAACS stipend, and if asked to do so, I agree to correspond with updates
each year with the person or persons who are donating money for my support.
PAACS Stipend Application – Revised February 11, 2013 Page 3 of 4
Yes
No
I accept in full the PAACS statement of belief as described below
PAACS STATEMENT OF BELIEF

We believe that the Bible, in its entirety, is the only inspired, inerrant Word of God.

We believe that there is one God eternally existent in three persons: the Father, the Son and
the Holy Spirit.

We believe that Jesus Christ is God the Son, born of a virgin, fully God and fully Man, who
willingly died on the cross for the sins of Man and rose from the dead to sit at the right hand of
the Father.

We believe that all men are by their very nature sinful and that the forgiveness of sin and the
gift of eternal life come only through repentance and faith in Jesus Christ.

We believe in the ministry of the Holy Spirit who indwells those who are born again by the
Spirit of God, and enables believers to live a godly life.

We believe in the personal return of Jesus Christ to reign in power and glory on the earth. He
will judge the saved and the lost – the saved will receive eternal life and the lost will receive
everlasting punishment.

We believe in the unity of all believers who love, worship and obey Jesus Christ as the Son of
God.

We believe that it is the duty of all who love and obey Jesus Christ to proclaim his gospel to
their neighbors and to the world and to respond with compassion to the suffering around them
in the ways that Jesus did, regardless of race, religion, nationality, or social status.
If you agree to all of the terms above, please sign below:
(Type your name)
Date:
____________________________________
(Your signature)
Electronic signature (ATTENTION: by checking this box you accept all of the conditions of this agreement)
If you have questions about the form, you may contact our Administrator, Terry McLamb at
terry.mclamb@paacs.net.
Return the completed electronic file by e-mail to admissions@paacs.net and paacs.ethiopia@gmail.com. Please
also include the two completed PAACS Ethiopia Spiritual Recommendation forms which have been filled out by
your references.
David C. Thompson, MD, FACS
PAACS Director for Africa
directorforafrica@paacs.net
PAACS Stipend Application – Revised February 11, 2013 Page 4 of 4