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ISPD Fellowship Application Form

This document outlines the application requirements for the ISPD Fellowship Program. Applicants must submit: a personal letter, CV, letter of support from their department head, and acceptance letter from their trainer. The application deadline is March 31st or September 30th and can be submitted via mail, fax, or email to the ISPD Global Operations Center. The application requests information about the applicant, their home institution, proposed trainer and training institute, training details and budget, rationale for applying, and future plans. ISPD will review applications and notify applicants of approval status and approved funding amount if applicable.

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Socheath Yem
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28 views

ISPD Fellowship Application Form

This document outlines the application requirements for the ISPD Fellowship Program. Applicants must submit: a personal letter, CV, letter of support from their department head, and acceptance letter from their trainer. The application deadline is March 31st or September 30th and can be submitted via mail, fax, or email to the ISPD Global Operations Center. The application requests information about the applicant, their home institution, proposed trainer and training institute, training details and budget, rationale for applying, and future plans. ISPD will review applications and notify applicants of approval status and approved funding amount if applicable.

Uploaded by

Socheath Yem
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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ISPD FELLOWSHIP PROGRAM

APPLICATION FORM

The completed application form must be accompanied by the following documents:

A Personal application letter (word or pdf file)

A personal curriculum vitae ((word or pdf file)

A supportive letter from head of the home Department or Hospital (word or pdf file)

An acceptance letter from the trainer (word or pdf file)

Application Submission Deadline: March 31 or September 30

Applications may be submitted by mail, fax or e-mail to the ISPD Headquarter:

ISPD Global Operations Center


Rue des Fabriques 1B
B1000 Brussels, BELGIUM
E-mail: [email protected]
Fax: +32 2 808 44 454
Phone: + 1 567 251 4018

INFORMATION ABOUT CANDIDATE AND HOME INSTITUTION

Family Name:
Given Name:
Year of Birth:
1
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Gender: Male Female
Country:
ISPD Membership: YES NO
E-mail:
Corresponding Address:
Institution Name:
Institution Address:
Position:
Head of the Department:

INFORMATION ABOUT TRAINER AND TRAINING INSTITUTE

Trainers Family Name:

Trainers Given Name:

Trainer Title:

ISPD Membership: YES NO

Training Institute:

Training Institute Address:

INFORMATION ABOUT TRAINING AND BUDGET

Training Duration:
Tentative Training:
Period:
Amount applied: USD
Budget breakdown:
Travelling:
Accommodation:
Living Expenses:
Insurance:
Others (please specify):

Rationale for applying ISPD Fellowship (MAX 250 words)

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www.ispd.org

Your future plan after training: (MAX 250 words)

FOR ISPD OFFICIAL USE

Approval: YES NO

Amount Approved by ISPD:

Remarks:

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