Fellowship Application Fellowship Application First name Last name Current professional position Institution Land AfghanistanAland IslandsAlbanienAlgerienAmerikanischen Samoa-InselnAndorraAngolaAnguillaAntarktisAntigua und BarbudaArgentinienArmenienArubaAustralienÖsterreichAserbaidschanBahamasBahrainBangladeschBarbadosWeißrusslandBelgienBelizeBeninBermudaBhutanBolivienBonaire, Sint Eustatius and SabaBosnien und HerzegowinaBotswanaBouvet IslandBrasilienBritish Indian Ocean TerritoryBruneiBulgarienBurkina FasoBurundiCôte d'IvoireKambodschaKamerunKanadaKap VerdeCayman InselnZentralafrikanische RepublikTschadChileChinaChristmas IslandCocos (Keeling) IslandsKolumbienKomorenKongoCook IslandsCosta RicaKroatienKubaCuracaoZypernTschechienDänemarkDschibutiDominicaDominikanische RepublikOsttimorEcuadorÄgyptenEl SalvadorÄquatorialguineaEritreaEstlandÄthiopienFalkland Islands (Malvinas)Faroe IslandsFidschiFinnlandFrankreichFranzösisch-GuayanaFranzösisch PolynesienFrench Southern TerritoriesGabunGambiaGeorgiaDeutschlandGhanaGibraltarGriechenlandGrönlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHongkongUngarnIslandIndienIndonesienIranIrakIrlandIsle of ManIsraelItalienJamaikaJapanJerseyJordanienKasachstanKeniaKiribatiKosovoKuwaitKirgisistanLaosLettlandLibanonLesothoLiberiaLibyenLiechtensteinLitauenLuxemburgMacaoMazedonienMadagaskarMalawiMalaysiaMaledivenMaliMaltaMarshallinselnMartiniqueMauretanienMauritiusMayotteMexikoMikronesienMoldawienMonacoMongoleiMontenegroMontserratMarokkoMosambikMyanmarNamibiaNauruNepalNiederlandeNew CaledoniaNeuseelandNicaraguaNigerNigeriaNiueNorfolk IslandNord KoreaNördliche MarianneninselnNorwegenOmanPakistanPalauPalästinaPanamaPapua Neu-GuineaParaguayPeruPhilippinenPitcairnPolenPortugalPuerto RicoKatarReunionRumänienRusslandRuandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSt. Kitts und NevisSt. LuciaSaint Martin (French part)Saint Pierre and MiquelonSt. Vincent und die GrenadinenSamoaSan MarinoSão Tomé und PríncipeSaudi-ArabienSenegalSerbiaSeychellenSierra LeoneSingapurSint Maarten (Dutch part)SlowakeiSlowenienSalomon-InselnSomaliaSüdafrikaSouth Georgia and the South Sandwich IslandsSüdkoreaSüdsudanSpanienSri LankaSudanSurinamSvalbard and Jan MayenSwasilandSchwedenSchweizSyrienTaiwanTadschikistanTansaniaThailandTimor-LesteGehenTokelauTongaTrinidad und TobagoTunesienTruthahnTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineVereinigte Arabische EmirateGroßbritannienVereinigte StaatenUnited States Minor Outlying IslandsUruguayUsbekistanVanuatuVatikanstadtVenezuelaVietnamVirgin Inseln, BritischJungferninseln, USAWallis and FutunaWestern SaharaJemenSambiaZimbabwe Kontakt E-mail 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 erreichen Years in post (eg 2016 – 2021) unterrichten Years in post (eg 2016 – 2021) Pfirsich Years in post (eg 2016 – 2021) Beratungsausschuss 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 Forschung Lehren Other (please describe)Other (please describe) Poster Years (eg year of conference) Forschung 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. Legen Sie hier eine Datei ab oder klicken Sie zum Hochladen Datei wählen Maximale Dateigröße: 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 NEIN 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. Falls Du menschlich bist, lasse dieses Feld leer. Einreichen
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