• 19057
777539

Pediatric Neuro-oncology Fellowship-Track 1

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    Applicant Personal Information

    Full Name*
    Date of Birth* (dd/mm/yyyy)
    Gender
    		MaleFemale
    Nationality*
    Country ID Number*
    Languages Spoken
    Language*TOEFLIELTS
    Marks*
    Contact Information
    Mobile Phone*
    Email Address 1*
    Email Address 2*
    Educational Qualifications
    Type of QualificationInstitutionYearGrade
    Bachelor Degree B. Sc.*
    Master’s Degree / Equivalent Degree*
    Doctorate /PHD

    Past Work Experience

    Hospital / Institute NameStart DateEnd Date

    Post-graduate Medical Courses/ scientific meetings and conferences Relevant to Pediatric Oncology:(Yes or No)

    Course NameInstitutionCertificate ReceivedYear

    National/ International Hospital Training

    Hospital Name*Observer/ Resident / FellowDuration in MonthsDate Started
    Extra-curricular activities
    Extra-curricular activitiesYesNo
    Course NameYear

    References: please list three references (at least Two professional references from senior physicians on official letterhead using the attached format)

    Reference 1
    Name
    Title
    Phone Numbers
    E-mails
    Institution/Hospital Name
    Reference 2
    Name
    Title
    Phone Numbers
    E-mails
    Institution/Hospital Name
    Reference 3
    Name
    Title
    Phone Numbers
    E-mails
    Institution/Hospital Name
    Present Position & ResponsibilitiesStart Date

    Documents Required

    • Copy of National ID or Passport
    • Curriculum vitae (CV)
    • Any Academic Certificates
    • Translational research project Proposal (not more than 2 Pages)
    • Statement of Purpose (motivation Letter)
    • Letters of Recommendation
    • TOEFL / IELTS Transcript

    Declaration
    I hereby declare that all the information provided in this application form is true and accurate to the best of my knowledge. I understand that any false or misleading information may result in the rejection of my application

    Contact Us

    Program Coordinator

    Program Director