IOFF-Subspecialty Fellowship Application

Application for an IOFF-Subspecialty Fellowship award

For questions, please consult the FAQ's or contact cgo@ioff.org. If a question does not apply to you, please enter "no".
Which IOFF-Subspecialty Fellowship Opportunity do you wish to apply for? *
Which subspecialty would you like to train? *
Name.*

Last NameGiven NameMiddle NameNamenssuffix
What name should appear on your certificate? Give your full name. *
Date of Birth.*

MonthDayYear
Your postaddress.*
Your mobile number.*

Country codePrefixNumber
Your email address.*
Repeat your email address.*
Your nationality. *
Do you have a second nationality? *
Your gender. *
Your marital status. *
Number of children. *
Name of your emergency contact. Relation to your emergency contact.*
Email address of your emergency contact.*
Your current position.*
Candidate's Plans. Please consider well your answers and explain in detail.*
1. What exactly do you wish to learn and why? What is your motivation?
2. What are the practical implications of your fellowship for your own professional development?
3. What are your plans upon return to your home country? How will your home institute benefit from you attending the IOFF Subspecialty Fellowship Program?
Were you granted a fellowship before (e. g. SOE/AAO/ICO)? Which, in what year?*
Qualifications and Honors in Ophthalmology. Incl. Ophthalmology Foundation Exams, COECSA, ICO Exams and EBO certificates.*
Your Employment History in Ophthalmology. List ALL your present and previous positions. Start with your residency training position.*
Teaching Activity. *
Volunteer/Charity Activity. *
Conference Activity. *
Research Activity. *
Your Publications. *
Upload area.*

* Scan of your passport, * Picture portrait, * "Specialist in Ophthalmology" degree certificate, * Confirmation issued by your present chair that you have completed your Residency Training, * Recommendation letter of your present chair, * Recommendation letter of your previous chair, * Recommendation letter of the chairperson of your charity/voluntary work position (if any), * ICO Exams certificates and EBO certificate (if available). All documents should be duly signed, be stamped with institute's stamp and be issued in English language. If not issued in English language please include a certified translation of the document to the original version.
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What describes your language skills best. Enter the language and tick.*

	language	proficient	intermediate	basic
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3.

Will you acquire basic knowledge of the language spoken in the host country?*

YESNO
Funding source.*

I wish to apply for funding to help cover my expenses for round-trip-travel and student-style living.I will cover my expenses by my own means, so do not apply for funding.
Candidate's Declaration. Please read carefully and confirm.*

I have read the program's information and instructions. I will respect the rule not to contact more than ONE host institute at a time.I hereby agree to work hard to achieve my aims and to derive maximum benefit from my training.I am able to communicate fluently in one of the languages offered in the chosen training centre.I guarantee that I will return to my home country immediately after having completed the IOFF-Subspecialty Fellowship to teach my colleagues and to apply what I have learned.I allow that the IOFF e. V. uses my bank data for the transfer of the IOFF-Subspeciality Fellowship Grant.I guarantee that I will resume my old position upon completion of the IOFF-Three-Month Subspeciality Fellowship. Or if I am applying for a one-year fellowship, I guarantee that I will participate in a teaching or public service position upon completion of the fellowship.At the end of my fellowship, I will send my report, pictures and an appreciation letter to my host and the fellowship supporter, as well as submit a copy of it to the IOFF office. Upon request I will take part in evaluation surveys.I will make sure that I can be contacted by email at any time. I will inform the IOFF office of any changes (e. g. emailaddress) immediately.I allow that the IOFF and the Ophthalmology Foundation use my contact data for newsletters or other information.I give my consent that any pictures and reports may be published by the IOFF.Should I be involved in a publication during the IOFF-Subspecialty Fellowship I am aware that I am obliged to acknowledge the IOFF e. V. and my sponsor. I agree to allow the IOFF e. V. to publish the paper on a platform to make it accessible for IOFF e. V. and others.I understand that I may be obliged to pay back all funding received: if any of the above information is subsequently found to be intentionally misleading, if I do not finish my training, or if I fail to submit the required reports and/or appreciation letter.I certify that everything stated in this application is true to the best of my knowledge.By submitting my application file, I confirm that I respect all points of the Candidate's declaration and the FAQ's.
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Application for an IOFF-Subspecialty Fellowship award