fellowship
fellowship
International FellowshipInternational Fellowship
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Application Form
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Personal Information

First name*
Last name*
Gender*
Date of birth*
Age*
Nationality*
Country of Residence*
Passport Number*
Title*
Degree*  M.D.   Ph.D.   M.S.   B.S.   Other 
Category*
Affiliation*
Department*
Email Address*
Phone Number*
Address*
Photograph
(upper half of body) *		 File format : PDF, JPG
KSUM international membership(Y/N)*
Year(s) of KSUM international membership*
Year(s) of KSUM Attendance*

Academic Background

Undergraduate Degree* University/Institution Name*
Degree Title*
Major/Field of Study*
Year of Completion*

Graduate Degree
(if applicable)		 University/Institution Name
Degree Title
Major/Field of Study
Year of Completion

Professional Experience*
List of Presentations at International Scientific Meetings (Last 5 Years)*
List of Publications (Last 5 Years) (follow the style of Index Medicus)*

KSUM International Fellowship Training

Training Preference*
Fellowship Requested Field*
Preferred Institution or Research Area*
Training Period Please indicate your preferred training period for the fellowship.*
Special remarks*
Motivation Statement*
(File Format : jpg, gif, bmp, png, pdf) 		In a separate document, please attach a motivation statement addressing the following points Why are you interested in the International Fellowship? How will this fellowship contribute to your professional development and career goals? How do you plan to apply the knowledge and skills acquired during the fellowship in your home country or community?

Supporting Documents

Recommendation Letters*
(File Format : jpg, gif, bmp, png, pdf) 		Addressed to the President of KSUM from the President of their national society of ultrasound in medicine
Curriculum Vitae*
(File Format : jpg, gif, bmp, png, pdf) 		Attach your up-to-date resume or curriculum vitae, including details of your educational background, work experience, publications (if any), any relevant certifications and SCIE Publications with Impact Factor
Medical report (form available online)*
(File Format : doc, pdf) 		Form downlaod
Written pledge (form available online)*
(File Format : doc, pdf) 		Form downlaod
Passport Copy*
(File Format : jpg, gif, bmp, png, pdf)
Diploma*
(File Format : jpg, gif, bmp, png, pdf)
Certificate of Medical License*
(File Format : jpg, gif, bmp, png, pdf)
Certificate of Employment*
(File Format : jpg, gif, bmp, png, pdf)