2025 EHDN/MDS Fellowship Application Form
Sponsored by EHDN & MDS-ES
Applicant details
Name
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First Name
Last Name
Permanent Address
*
Street Address
Street Address Line 2
City
State / Province
Postal Code
Home Country
*
Phone number (with country code)
Title of Degree
*
Year of degree
*
Email
*
example@example.com
Citizenship
*
Home institution
*
Head of department
*
Date of birth
*
-
Day
-
Month
Year
Date
Age group
25-30
31-35
36-40
41-45
Gender
Male
Female
Prefer not to say
no specific gender
Native Language
*
English
Spanish
German
French
Ukranian
Arabic
Italian
Other
Other languages (if any)
I am qualified as a healthcare professional in
*
(Name country of qualification)
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I am currently registered in a training programme neurology, psychiatry, psychology, physiotherapy or clinical genetics or other HD related discipline at the above institution
I have completed a training programme in neurology, psychiatry, psychology, physiotherapy or clinical genetics or other HD related discipline and am now working at the above institution
I have been actively involved in HD research/clinical practice, or have future project plans in HD research/clinical practice
I will not receive any other financial support for this Fellowship from any other party. If I do so, I will inform EHDN immediately.
I am an EHDN member
I am an MDS member
Fellowship purpose and goals
Clearly describe your goals and interests for this clinical fellowship (minimum 350-max. 500 words):
*
0/500
Clinical Interests and Location Preferences
In which area of clinical expertise related to Huntington's Disease are you most interested in gaining experience in during the fellowship? (e.g. movement disorders, psychiatric care, genetic counselling, etc.) and how is this important to your future work? (minimum 100 words-max. 300 words)
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0/300
What dates during 2025 (6 weeks) could you be available to do your placement (if offered)?
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Do you have a preference for which clinic/country in which you would like to complete your fellowship? If so, please state reason and list in order of preference. (You must have a good working knowledge of the local language)
*
What concrete steps would you take to ensure that your learning from the placement (if offered) will be brought back to your local clinic, HD patients and families? (minimum 100 words - max. 300 words)
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0/300
If any of the above criteria are not applicable, please explain here
Where did you hear about this fellowship opportunity?
*
Please Select
EHDN website
EHDN social media
EHDN newsletter
MDS newsletter
MDS email
EHDN email
Other
If other is marked above, please give more information
In gathering the data for this application we want to ensure GDPR (General data protection regulation) compliance. Your privacy is very important to us. By participating in this application process you are agreeing to provide certain personal data collected such as your name and contact details. These will be used solely for evaluating your fellowship application and will not be shared. Your information will be securely stored and will be accessible only to specific staff and representatives from the European Huntington’s Disease Network & the Movement Disorders Society working on this project and the evaluation of applications. You have the right to access, rectify, or erase your data by emailing your request to info@ehdn.org. I am aware that, if granted the fellowship, that it is my responsibility to verify that I am entitled to enter the host country. EHDN & MDS cannot assist with VISA applications. I confirm with my signature the accuracy and completeness of the information I have provided above. In order to ensure that my data remains up to date, I will notify the EHDN Fellowship team (fep@euro-hd.net) of any changes referring to this application immediately.
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Curriculum Vitae (max. 3 pages, 1 PDF document only entitled Surname, First Name CV)
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Statement letter from home institution as provided by EHDN on fellowship website page (PDF document only entitled Surname, First Name_statement)
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Copy of passport/ National Identity Card (pdf document only entitled Surname, First name_passport )
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Copy of professional degree(s)- pdf document only entitled Surname, First name_degrees
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Copy of professional registration document- pdf document only entitled Surname, First name_registration
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