Clack Fellowship Application Form

The Foundation for International Education in Neurological Surgery (FIENS)/Clack Family Fellowship supports neurosurgical trainees from areas of the world without sufficient neurosurgical coverage, who are aspiring to complete training and need monetary help to do so.

This award will provide funding for neurosurgeons who, at the time of their application, are enrolled in a neurosurgery residency program, come from a low-or middle-income country, and affirm they will return to service in their home country or another country of need.

Two fellowships will be awarded yearly on the basis of a competitive evaluation by a committee composed of FIENS members. The maximum fellowship stipend is $11,000.

Applications are accepted on a rolling basis with review periods occurring in August and February of each year. All applicants will receive notification within 4-6 weeks after the review period.

In order for your application to be considered you must:

Be enrolled in a neurosurgery residency program
Intend to practice in your home country or another country of need upon completion of your fellowship
Be able to articulate your financial need and explain how this funding will allow you to complete your neurosurgical training

Full Name*

First NameLast Name

E-mail*

example@example.com

Mailing Address

Street Address

Street Address Line 2 (Or P.O. Box)

CityState / Province/Area

Postal / Zip CodeCountry

Phone Number *

Please include country code

Do you have your phone number registered on WhatsApp?*

YesNo

If you answered Yes to the above question, may we contact you on WhatsApp?*

YesNo

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.

How did you hear about the Clack Family Fellowship?*

If you answered Other to the question above, please indicate where you heard about the fellowship.

Please list all grants, fellowships and/or awards that you have received, are in consideration for, or are intending to apply to in addition to this fellowship. *

*Please note, failure to disclose this information could result in your application being disqualified.

Clack Family Scholarship Application

Contact Information

Demographic Information

Training Program Description

Letter of Recommendation

Education/Research/Work Experience

Award Information

Reporting and Requirements