CASL CLINICAL FELLOWSHIP APPLICATION FORM

CASL CLINICAL FELLOWSHIP APPLICATION FORM
Goal of Fellowship

The CASL Clinical Hepatology Fellowship aims to support those with a primary interest in liver disease to provide advanced training in the clinical management and research of liver diseases.

Please read the guidelines before starting the application.

Terms of Award

Clinical Fellowships are for a period of one year.

The Clinical Fellowship is intended to provide income to the recipient throughout their hepatology fellowship.  The award is to be used to cover living expenses while completing the fellowship.

The applicant may request an award of up to $70,000. The application must include an outline of how the funds will be used, including any employer obligations as per CRA regulations.

The applicant must provide evidence of the likelihood of practicing in Canada following their fellowship, as the intent of this funding is to further the treatment of liver disease within Canada. The application for fellowship should explicitly address this issue.

The supervisor for the applicant is required to review and sign off on the terms of the award.

The Fellowship will normally commence on July 1,2026.  The Association will make payments to the fellow’s institution, to then be paid out as per the terms of the fellowship. Fellowships starting on dates other than July 1 will be accepted but start dates should be expressly noted in the fellowship application to allow for expedient payment.

If at any point in time, the recipient needs to delay the fellowship, a request must be made in writing to the Canadian Association for the Study of the Liver. NOTE: additional funding will not be provided for the additional time taken.

Any changes or questions regarding the payment instructions above must be made in writing, within 30 days of accepting the fellowship.

Access to any Publications
- Fellowship recipients are required to make every effort to ensure that any peer-reviewed publications created during their fellowship are freely accessible through the Publisher’s website (Option #1) or an online repository as soon as possible and in any event within six months of publication (Option #2).
- An electronic version of peer-reviewed publications should be submitted to the Association as soon as they are available.
- CASL need to acknowledge as granting agency in all publications/presentations resulting from work during the fellowship.
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Applicant Information
General InformationApplicants and fellowship supervisors must both be CASL members. By checking the boxes below, you are acknowledging that you both have current CASL memberships.

Applicant is a CASL memberFellowship Supervisor is a CASL member
If you are not a member, click here to sign up before applying.
Expected Fellowship Start Date:

MonthDayYear
Date
Please Note: The Fellowship will normally commence on July 1 of the year following the application. The Association will make payments directly to the fellow’s institution, to then be paid out as per the terms of the Fellowship. Fellowships starting on dates other than July 1 will be accepted but start dates should be expressly noted in the fellowship application to allow for expedient payment.

If at any point in time, the recipient needs to delay the fellowship, a request must be made in writing to the Canadian Association for the Study of the Liver. NOTE: additional funding will not be provided for the additional time taken.
Applicant’s Prefix, First and Last Name
Email Address
example@example.com
CC Email Address (if applicable)
example@example.com
Applicant’s Degree(s) and Year(s) granted
Applicant’s Degree(s) and Year(s) granted
Applicant’s Degree(s) and Year(s) granted
Current Position
Appointment Date (month/year)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Office Telephone
Please enter a valid phone number.
Applicant’s Citizenship Status in Canada
Supporting Institution and Fellowship Supervisor Information
Name of Supporting Institution
Institution Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Supervisor’s Prefix, First and Last Name
Supervisor's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Supervisor’s Office Telephone
Please enter a valid phone number.
Email Address
example@example.com

Required Documents
Curriculum Vitae of Applicant: Provide a biographical sketch including any publications, abstracts, or presentations.

Curriculum Vitae of Applicant
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Candidate’s Statement: Statement of applicant’s career plans and the potential benefit to the applicant of the proposed training program (1 page).

Candidate’s Statement
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Clinical Program Description: The training institution must submit a detailed description of the curriculum, including monthly schedule of training and patient care responsibilities (maximum: 2 pages). Inclusion of a monthly schedule in tabular format is encouraged.

Clinical Program Description
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Letter of Departmental Support: Letter should be provided from the Department or Program Chair of the proposed training institution, describing the commitment of institutional resources, support and environment to the applicant and supervisor (1 page).

Letter of Departmental Support
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Signed Letter from Proposed Fellowship Supervisor: The fellowship supervisor must submit a letter confirming their sponsorship of the applicant (1 page).

Signed Letter from Proposed Fellowship Supervisor
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Signed Letter from Current Supervisor: The applicant’s current supervisor/mentor must submit a letter confirming their support of theapplicant, and intention to continue providing mentorship as required duringthe Fellowship term (1 page).

Signed Letter from Current Supervisor
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Letters of Reference: Letter from two (2) other physicians well acquainted with your abilities.

Letters of Reference
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Should you have any questions regarding the application process, please email the CASL office at casl@hepatology.ca

Applicable Signatures

Note: Your signatures below indicate that the applicant meets the eligibility criteria for this fellowship program and that the information in this application is accurate to the best of your knowledge
Signature of Applicant

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Name

First NameLast Name
Date

MonthDayYear
Date
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CASL CLINICAL FELLOWSHIP APPLICATION FORM

Applicant Information

Supporting Institution and Fellowship Supervisor Information

Required Documents

Applicable Signatures