Bassett Fellowship Application

Bassett Fellowship Application
The Foundation for International Education in Neurological Surgery (FIENS)/Bassett Fellowship offers an international traveling fellowship for neurosurgeons who, at the time of their application, are either training in a residency program in a low-or-middle income country or who have completed residency training in a low-or-middle income country within the past five years.

The fellowship will cover the traveling and living expenses for a three-month period to be spent observing the activities of a neurosurgical service that has an established relationship with FIENS. Fellowships will be awarded yearly on the basis of a competitive evaluation by a committee composed of FIENS members. The maximum fellowship stipend is $7,000.

Applications are accepted on a rolling basis with review periods occurring May 1 and November 1 of each year. Applicants will receive notification by the end of May and the end of November.

Your application must include:
- A statement defining the purpose of your proposed fellowship that includes a statement of your intention to return to your home country after completion of the fellowship.
- A letter of recommendation from your neurosurgical program director or other neurosurgeon with whom you have worked closely with.
- A letter of acceptance from the institution where you intend to pursue the fellowship, confirming the description of your planned activities during the period of the award.
- Your current curriculum vitae.
Please explain the purpose of your proposed fellowship.*
Contact Information
Name*

FIRST NameLAST Name
E-mail*
example@example.com
Address

Street Address

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CityState / Province

Postal / Zip CodeCountry
Phone Number*
Please include country code
Please enter the name of the country you will return to and will be practicing in once you complete your fellowship.*
Is this the first time you have submitted an application for this fellowship?*

YesNo
If you answered 'No' to the previous question, please note what years you have applied.
Please tell us how you heard about this fellowship

FIENS WebsiteInterSurgeonWFNS NewsletterFIENS Facebook or TwitterOther
If you enter Other, above, please tell us how you heard about the fellowship

Demographic Information

*All questions are optional
What is your gender?
What is your race?
Please list the languages that you speak.
Which category below includes your age?
Do you identify as a person with a disability?
If you selected Other, please describe below.

Statement of Purpose

Please attach a complete Statement of Purpose below.
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Letter of Recommendation
Please attach a Letter of Recommendation from your neurosurgical program director or other neurosurgeon with whom you have worked closely with.*

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Letter of Acceptance
Please enter the start date of the proposed fellowship*

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Date
Please enter the end date of the proposed fellowship*

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Date
Please enter the institution of the proposed fellowship*
Please enter the contact name of the Host/Sponsor*
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Please enter the email of the Host/Sponsor*
Please attach a Letter of Acceptance from the institution where you intend to pursue your fellowship, confirming the description of the fellow’s planned activities during the period of the fellowship. *

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Education/Research/Work Experience
Please attach your curriculum vitae or resume (a short written summary of a your career, qualifications, and education)*

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Host/Sponsor Information
Host/Sponsor Email
example@example.com
Host/Sponsor Phone Number
Please include country code

Reporting and Requirements
Signature*

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Bassett Fellowship Application

Contact Information

Demographic Information

Statement of Purpose

Letter of Recommendation

Letter of Acceptance

Education/Research/Work Experience

Host/Sponsor Information

Reporting and Requirements