ONLINE APPLICATION FORM - ESES - EUROPEAN SOCIETY OF ENDOCRINE SURGEONS

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ONLINE APPLICATION FORM

JFH Scholarship
 
Fields with asterisk (*) required.
Hospital*
University affilliation*
Country*
Name of candidate*
Date of birth*
E-mail*
Number of endocrine surgeries performed*

Number of operations performed annually:
Thyroid*
Parathyroid*
Adrenal*
GEP-NET*

History of training, career profile (state degree, qualifications, hospital and mentors, etc.):* (characters left: 2500)
Main field of interest*
Specific goal of travel fellowship*

Involvement in the ESES by surgeons at the applying host institution:
Member (junior) of the ESES since*
Senior ESES member supporting application*
Participation at ESES congresses/workshops (year)*
DES examination in endocrine surgery*  
 
List of publications on endocrine topics in the last 3 years* (characters left: 2500)
Specify languages and level of competence to communicate/converse with clinicians* (characters left: 300)


List of priority of centres/mentors to visit - priority 1
centre*
mentor*
full time scholarship*
preferred period of scholarship*
List of priority of centres/mentors to visit - priority 2
centre*
mentor*
full time scholarship*
preferred period of scholarship*
List of priority of centres/mentors to visit - priority 3
centre*
mentor*
full time scholarship*
preferred period of scholarship*


List of priority of specific surgeries/disease management type to experience - priority 1
organ*
type of surgery*
full time scholarship*
preferred period of scholarship*
List of priority of specific surgeries/disease management type to experience - priority 2
organ*
type of surgery*
full time scholarship*
preferred period of scholarship*
List of priority of specific surgeries/disease management type to experience - priority 3
organ*
type of surgery*
full time scholarship*
preferred period of scholarship*


   
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