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Application form

2008
From Bedside to Bench
Translational medicine course for the basic scientist
Module on Female Reproductive Health

Internet-based learning course
1 September 2008 – 22 October 2008
 
On-site course - WHO Headquarters Geneva
27-31 October 2008

Registration is closed
New dates to be announced soon

organised by

the Geneva Foundation for Medical Education and Research
(WHO Collaborating Centre in Education and Research in Human Reproduction),
and
the 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 Course “From bedside to bench”

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)

Research interests and topics (state your research field and short list of 10 most important publications)
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 evaluation-discussions 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
 FINANCING
If you are accepted to the Course, please indicate,
who will finance your participation in the Course

I will pay all costs myself  

I have already found funding
...............they will pay all my costs
.............. they will pay some of my costs
...............details (who/how-much/etc.)

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
2. copies of PhD and other 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 page outline of the research project/thesis that you hope to develope as part of the exams
5. a letter of reference, preferably form your current employer

All application documents should be sent electronically (secretariat@gfmer.org) including pdf of letters and copies of diplomas. The deadline for receipt of applications is August 15, 2008.

Documents to be dispatched by post/fax should be sent to:

Course “From bedside to bench”

Geneva Foundation for Medical Education and Research

Chemin Edouard-Tavan 5

CH-1206 Geneva

Switzerland

Fax: +0041.22.346.78.34

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Edited by Aldo Campana,