Fellowship Application Fellowship Application First name Last name Current professional position Institution Land AfghanistanAland IslandsAlbanienAlgerietAmerikansk SamoaAndorraAngolaAnguillaAntarktisAntigua og BarbudaArgentinaArmenienArubaAustralienØstrigAserbajdsjanBahamasBahrainBangladeshBarbadosHvideruslandBelgienBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnien-HercegovinaBotswanaBouvet IslandBrasilienBritish Indian Ocean TerritoryBruneiBulgarienBurkina FasoBurundiCôte d'IvoireCambodjaCamerounCanadaKap VerdeCaymanøerneDen Centralafrikanske RepublikTchadChileKinaChristmas IslandCocos (Keeling) IslandsColombiaComorerneCongoCook IslandsCosta RicaKroatienCubaCuracaoCypernTjekkietDanmarkDjiboutiDominicaDominikanske republikØst TimorEcuadorEgyptenEl SalvadorÆkvatorial GuineaEritreaEstlandEtiopienFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFrankrigFransk GuyanaFransk PolynesienFrench Southern TerritoriesGabonGambiaGeorgienTysklandGhanaGibraltarGrækenlandGrønlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongUngarnIslandIndienIndonesienIranIrakIrlandIsle of ManIsraelItalienJamaicaJapanJerseyJordanKasakhstanKenyaKiribatiKosovoKuwaitKirgisistanLaosLetlandLibanonLesothoLiberiaLibyenLiechtensteinLitauenLuxembourgMacaoMakedonienMadagaskarMalawiMalaysiaMaldiverneMaliMaltaMarshalløerneMartiniqueMauretanienMauritiusMayotteMexicoMikronesienMoldovaMonacoMongolietMontenegroMontserratMarokkoMozambiqueMyanmarNamibiaNauruNepalHollandNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNordkoreaNordmarianerneNorgeOmanPakistanPalauPalæstinaPanamaPapua Ny GuineaParaguayPeruFilippinernePitcairnPolenPortugalPuerto RicoQatarReunionRumænienRuslandRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts og NevisSankt LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent og GrenadinerneSamoaSan MarinoSao Tome og PrincipeSaudi ArabienSenegalSerbiaSeychellerneSierra LeoneSingaporeSint Maarten (Dutch part)SlovakietSlovenienSalomonøerneSomaliaSydafrikaSouth Georgia and the South Sandwich IslandsSydkoreaSydsudanSpanienSri LankaSudanSurinamSvalbard and Jan MayenSwazilandSverigeSchweizSyrienTaiwanTadsjikistanTanzaniaThailandTimor-LesteAt gåTokelauTongaTrinidad og TobagoTunesienKalkunTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineForenede Arabiske EmiraterDet Forenede KongerigeForenede StaterUnited States Minor Outlying IslandsUruguayUsbekistanVanuatuVatikanetVenezuelaVietnamJomfruøerne, britiskJomfruøerne, USAWallis and FutunaWestern SaharaYemenZambiaZimbabwe Contact Email Number of years as EACH member (a minimum of 6 does not have to be consecutive) Biographical statement Please include any relevant achievements in relation to healthcare communication. (Maximum of 250 words) Word count: Contribution to EACH nå Years in post (eg 2016 – 2021) underviser Years in post (eg 2016 – 2021) fersken Years in post (eg 2016 – 2021) Rådgivende udvalg Years in post (eg 2016 – 2021) Special Interest Group Years in post (eg 2016 – 2021) EACH periodic committee membership/participation Below please indicate the years of your involvement/participation on any of the following committees. ICCH planning committee Years (eg year of conference) Forum planning committee Years (eg year of conference) Summer school planning committee/facilitator Years (eg year of conference) ICCH/Forum abstract reviewer Years (eg year of conference) Senior in Pairing with Colleagues initiative Years (eg year of conference) Member of Expert Jury for EACH Awards Poster Forskning Undervisning Other (please describe)Other (please describe) Poster Years (eg year of conference) Forskning Years (eg year of conference) Teaching Award Years (eg year of conference) Description of your contributions to EACH projects, products and dissemination activities: Please describe your contributions to EACH projects, products and dissemination activities – use as much space as needed. (Note – some of these contributions may be in your capacity as a standing EACH committee member). To add the series of questions for an additional activity (up to a maximum of five), please click the toggle on, after the detailed description field. Activity 1 Name/description of project, product, activity and your role in it (Maximum of 300 words) Word Count: Which committee if applicable, was this activity related to? Dates of contribution Who would be best to comment on your involvement in this activity? eg sub-committee, chair, project lead etc. (Please include their email address.) To complete the questions in respect of a second activity, please click to toggle on. Toggle 2 Activity 2 Name/description of project, product, activity and your role in it (Maximum of 300 words) Word count: Which committee if applicable, was this activity related to? Dates of contribution Who would be best to comment on your involvement in this activity? eg sub-committee, chair, project lead etc. (Please include their email address.) To complete the questions in respect of a third activity, please click to toggle on. Toggle 3 Activity 3 Name/description of project, product, activity and your role in it (Maximum of 300 words) Word Count: Which committee if applicable, was this activity related to? Dates of contribution Who would be best to comment on your involvement in this activity? eg sub-committee, chair, project lead etc. (Please include their email address.) To complete the questions in respect of a fourth activity, please click to toggle on. Toggle 4 Activity 4 Name/description of project, product, activity and your role in it (Maximum of 300 words) Word Count: Which committee if applicable, was this activity related to? Dates of contribution Who would be best to comment on your involvement in this activity? eg sub-committee, chair, project lead etc. (Please include their email address.) To complete the questions in respect of a fifth activity, please click to toggle on. Toggle 5 Activity 5 Name/description of project, product, activity and your role in it (Maximum of 300 words) Word count: Which committee if applicable, was this activity related to? Dates of contribution Who would be best to comment on your involvement in this activity? eg sub-committee, chair, project lead etc. (Please include their email address.) Candidate Letter of Application Please upload a word document or pdf of a 1 page single spaced application letter briefly describing the reasons why you should qualify for the Fellowship and highlighting your most substantive contributions to EACH. You should include in your letter any contributions you have made which progress the EACH aims. Drop a file here or click to upload Choose File Maximum file size: 2MB Additional comments Additional comments (if needed) (Maximum of 300 words) Word count If awarded, are you happy to have your name included on the EACH Fellowship webpage? * Ja Ingen I hereby declare that all the information contained in this application is true and correct, and if successfully awarded EACH Fellowship, I guarantee will maintain ethical and professional standards and not bring the Association into disrepute. Hvis du er et menneske, så lad dette felt stå tomt. Indsend
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