Emanuel Rosen Fellowship Application
Apply for the ESCRS Emanuel Rosen Fellowship by providing the required details and documents. Please complete all sections.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Confirm Email Address
*
example@example.com
Eligibility Confirmation
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I confirm I am a young ophthalmologist who has finalised their training in ophthalmology
I confirm I have not previously received this fellowship
I confirm I am an ESCRS member
ESCRS membership number
*
Nationality
*
Your Home Institution
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Brief Justification of your eligibility (max 200 words)
*
Proposed Host Institution Name
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Host Institution Country
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Proposed Host Mentor name
*
Do you have a pre-agreement with the host institution for the proposed fellowship?
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Yes
No
Outline clearly how you intend to secure a license to practice medicine in the proposed host country at the time of the start of the fellowship (150 words max)
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0/150
Do you have the necessary language requirements to work in the proposed host country?
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Yes
No
Proposed Fellowship Start Date (note that applications close 30 June and a decision will likely not be back with you until August at the earliest)
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-
Month
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Day
Year
Date
Proposed Fellowship End Date
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-
Month
-
Day
Year
Date
Upload CV (must include publications, research activities, awards. Should indicate clearly the applicants experience in ophthalmology including surgical experience)
*
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Upload Letter of Intent (1-2 pages, outlining your aims, cost to benefit relation, post-fellowship plans, which centre you wish to attend and why it will benefit your career, your home centre and ophthalmology in Europe)
*
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Upload 1-2 page Letter of support from your current Head of Department (outlining clearly their support for your fellowship and the impact that the training will have on the home centre and/or region)
*
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Upload 1-2 page Letter of Acceptance from Host Institution (indicating they are willing to host you for the time required and can fulfil your aims)
*
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Declarations & Consent
I declare that all information provided is accurate and complete
I consent to the processing of my data for fellowship application purposes by ESCRS and it's administrative partner
Signature
Please verify that you are human
*
Submit Application
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