APPLICATION AS HOST

APPLICATION AS HOST
Name of institution*
Address of institution*

Street

Straße und Hausnummer (zweite Zeile)

CityBundesland

Zip CodeCountry
Website*
Specialty focus / Areas of particular expertise*
Name of contact person*

First nameLast name
E-Mail*
example@example.com
Type of accommodation*
e.g. Hotel, Hostel, Private, etc.
Accomodation can be provided for free.*

YesNo
Duration accommodation can be provided (up to 2 weeks)*
Number of operations at the institution per week*
Number of residents*
Number of attendings*
Potential to scrub in (yes/no)*
Requirements to be allowed to scrub in:
Reasons for seeking a Fellowship at this institution (200 words)*
Should be Empty: