Brochure - GFMER Scholarship

GFMER Scholarship - Application form

2009

FROM RESEARCH TO PRACTICE

TRAINING IN SEXUAL AND REPRODUCTIVE HEALTH RESEARCH

Research Methodology

2 weeks

Sexual and Reproductive Health

2 weeks

2 February 2009 - 4 March 2009

organised by

the Geneva Foundation for Medical Education and Research
(WHO Collaborating Centre in Education and Research in Human Reproduction),
the International Association for Maternal and Neonatal Health (IAMANEH)
the San Raffaele del Monte Tabor Foundation
and
UNDP/UNFPA/WHO/World Bank Special Programme for Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research; Family and Community Health Cluster (WHO/RHR)

 
COURSE CHOICE

I wish to apply to participate in the Sexual and Reproductive Health Research Course

Yes No
PERSONAL DATA
Family name
First names

female male

Date and place of birth
Nationality
Position held at present (state your activities and responsibilities)

Previous employments (last 4)
Family status
ADDRESS, TELEPHONE, FAX, E-MAIL
Professional address
Telephone number and Fax number with country and area codes
Personal address
Telephone number and Fax number with country and area codes
E-mail address (If you don't have one, you could get one at no cost at Yahoo.com or Hotmail.com)
LANGUAGE SKILLS
Mother tongue 
Other languages Reading Writing Speaking
Excellent Good Fair Excellent Good Fair Excellent Good Fair
1.
2.
3.
4.
Please note that the lectures and exams will be held in English. Therefore, it is extremely important that your level of understanding, expressing yourself and writing in English is adequate.
EDUCATION
University studies
University
Country
Faculty
Successful exams and year of graduation
Obtained university title and exact field
Academic certificates or diplomas
and years when they were obtained
ACCOMMODATION
If you are accepted to the Course, please indicate,
if you would like the Course organisers to reserve
a student's room for you in Geneva
Yes      No
ENCLOSURES
Please attach the following documents:
1. curriculum vitae, including sections on: your current and previous positions; responsibilities in research, teaching and clinical work;
    the institution in which you work; and a list of publications (if available)
2. a certified copy of the diploma in medicine and any additional diplomas
3. a letter of motivation stating clearly your interests and reasons for applying to the Course (1 A 4 page maximum)
4. a 1-2 page summary of the research project/thesis that will be developed as part of the exams
5. an official attestation confirming your proficiency in the English language
6. two letters of reference, preferably one form your current employer
7. if possible, please submit the following document: an introduction by your Head of Department stating your role and future involvement
in your country's National Reproductive Health Programme