ASSRS Supervisor Criteria
Please complete the following to verify your eligibility as an Academic Surgeon-Scientist Research (ASSRS) supervisor. If you have any issues completing this form, please contact us: office@passewilliams.org.au

This information is collected as per the Passe & Williams Foundation Privacy Policy. We may share this information with third parities to confirm your eligibility as an ASSRS supervisor.
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Contact Details
Title *
First Name *
Surname *
Proposed Administering Institution *
Where the candidate will be enrolled for their PhD
Email address *
Please use your proposed Administering Institution email address
I consent to my contact details above being published on the approved supervisors list. *
The approved list will be published on the Foundation website, and may be shared by email.
Required
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