Fellowship Registration - Sankara Nethralaya

Program Selection

Select Your Specializations (not more than 2) *

Comprehensive Ophthalmology + Neuro Ophthalmology (21 months)

Select your preference:*

Preference 1

Preference 2

Personal Information

Full Name (as per Degree Certificate) *

Date of Birth *

Gender *

Marital Status *

Mobile Number *

Email Address *

Communication Address *

0 /334

State *

Country *

MBBS Degree

College *

University *

Year of Passing *

Total Marks Obtained *

Number of Attempts *

State Medical Council Registration Number *

Distinction, if any

0 /500

Post Graduate Qualification

Course *

Year of Passing *

College *

University *

Number of Attempts *

State Medical Council Registration Number

Total Marks Obtained *

Distinction, if any

0 /500

Additional Post Graduate Qualification

Course

Year of Passing

College

University

Number of Attempts

State Medical Council Registration Number

Total Marks Obtained

Distinction, if any

0 /500

Additional Qualification and Training (Other than Post Graduation)

Additional Qualification and Training(Programme details and Year of study)

0 /1000

Plus 2/Inter/PUC Details

Board

Medium

Year of Passing

Total Marks Obtained

Work Experience

Ophthalmic Experience

Enter your ophthalmic experience for the last 5 years, including the organization name and experience details.

1. organization Name

Experience Details

0 /1000

Miscellaneous Details (Enter none if no data available)

Medals/Awards*

0 /1000

Conferences Attended*

0 /1000

Papers Presented and Published*

0 /1000

Research Work, if any*

0 /1000

Present Employment or Educational Details*

0 /1000

Future Plans*

0 /1000

Why are you interested in this programme?*

0 /1000

Hobbies*

0 /1000

Competency Assessment

Please rate your skill level from 0 to 5 (0 = not competent, 5 = very competent) and provide the number of cases performed.

Clinical Skills *

Skill Description	Skill Level (0–5)	Cases Performed
Slit lamp Bio microscopy
Applanation Tonometry
Gonioscopy
Indirect Ophthalmoscope
YAG Laser Capsulotomy
YAG Laser PI
FFA Performing / Interpreting
OCT Performing / Interpreting
Retinal Laser Procedure
Operating Microscope & Control

Surgical Skills *

Surgery Type	Skill Level (0–5)	No. Performed
Cataract
ECCE
SICS
PHACO

Trabeculectomy / Glaucoma Procedures
Corneal / Pterygium Repair
Penetrating Keratoplasty
Squint Procedures
Oculoplasty / Lacrimal
Endophthalmitis / AC Tap / IVT
VR Surgery
Observed
Assisted
Performed

Languages Known

Language 1 *

Speak Read Write

Language 2

Speak Read Write

Language 3

Speak Read Write

Language 4

Speak Read Write

Professional References

I Reference *

0 /1000

II Reference *

0 /1000

III Reference

0 /1000

Other Details

Did you complete a mandatory service bond with a government body or medical college during your postgraduate studies? *

Yes No

Are you willing for assignments outside of Chennai or Kolkata, including overnight or extended stays? *

Yes No

Are you willing to manage night shifts and remain on-call for eye donations, ward duties, and emergencies? *

Yes No

Do you anticipate any personal, health, or external obligations that might affect your ability to complete this fellowship successfully? *

Yes No

Do you agree to a mandatory split-posting schedule between the Kolkata and Chennai centres for a fixed duration? *

Yes No

In the event that personal leave exceeds the permitted allowance, are you willing to extend your fellowship period to fulfil the requirements? *

Yes No

Family Information

Spouse Name

Occupation

Father Name*

Occupation*

Mother Name*

Occupation*

Number of Children

Supporting Documents & Photograph

Please upload clear copies of the following documents .

Recent Passport Photograph (Image File in .jpg or .png) *

Proof of Birth(.pdf(size:less than 1MB)) *

MBBS Degree Certificate (.pdf(size:less than 1MB))*

Post Graduate Degree/Diploma Certificate(.pdf(size:less than 1MB))*

SMC/MCI Registration Certificate (.pdf(size:less than 1MB))*

Internship Certificate(.pdf(size:less than 1MB)) *

Resume/Curriculum Vitae(.pdf(size:less than 1MB))*