Fellowship Application Fellowship Application First name Last name Current professional position Institución País AfganistánAland IslandsAlbaniaArgeliaSamoa AmericanaAndorraAngolaAnguilaAntártidaAntigua y BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaiyánbahamasBahréinBangladeshBarbadosBielorrusiaBélgicaBeliceBenínislas BermudasButánboliviaBonaire, Sint Eustatius and SabaBosnia y HerzegovinaBotsuanaBouvet IslandBrasilBritish Indian Ocean TerritoryBrunéiBulgariaBurkina FasoBurundiCôte d'IvoireCamboyaCamerúnCanadáCabo VerdeIslas CaimánRepública CentroafricanaChadChilePorcelanaChristmas IslandCocos (Keeling) IslandsColombiaComorasCongoCook IslandsCosta RicaCroaciaCubaCuracaoChipreRepública ChecaDinamarcaYibutirepública dominicanaRepública DominicanaTimor OrientalEcuadorEgiptoEl SalvadorGuinea EcuatorialEritreaEstoniaEtiopíaFalkland Islands (Malvinas)Faroe IslandsFiyiFinlandiaFranciaGuayana FrancesaPolinesia francésFrench Southern TerritoriesGabónGambiaGeorgiaAlemaniaGhanaGibraltarGreciaGroenlandiaGranadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BisáuGuayanaHaitíHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungríaIslandiaIndiaIndonesiaIránIrakIrlandaIsle of ManIsraelItaliaJamaicaJapónJerseyJordánKazajstánKeniaKiribatiKosovoKuwaitKirguistánLaosLetoniaLíbanoLesotoLiberiaLibiaLiechtensteinLituaniaLuxemburgoMacaomacedoniaMadagascarMalauiMalasiaMaldivasMalíMaltaIslas MarshallMartiniqueMauritaniaMauricioMayotteMéxicoMicronesiaMoldaviaMónacoMongoliaMontenegroMontserratMarruecosMozambiqueBirmaniaNamibiaNauruNepalPaíses BajosNew CaledoniaNueva ZelandaNicaraguaNígerNigeriaNiueNorfolk IslandCorea del NorteIslas Marianas del NorteNoruegaOmánPakistánPalaosPalestinaPanamáPapúa Nueva GuineaParaguayPerúFilipinasPitcairnPoloniaPortugalPuerto RicoKatarReunionRumaniaRusiaRuandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSan Cristóbal y NievesSanta LucíaSaint Martin (French part)Saint Pierre and MiquelonSan Vicente y las GranadinasSamoaSan MarinoSanto Tomé y PríncipeArabia SauditaSenegalSerbiaSeychellesSierra LeonaSingapurSint Maarten (Dutch part)EslovaquiaEsloveniaIslas SalomónSomaliaSudáfricaSouth Georgia and the South Sandwich IslandsCorea del SurSudán del SurEspañaSri LankaSudánSurinamSvalbard and Jan MayenSuazilandiaSueciaSuizaSiriaTaiwánTayikistánTanzaniaTailandiaTimor-LesteIrTokelauTongaTrinidad y TobagoTúnezPavoTurkmenistánTurks and Caicos IslandsTuvaluUgandaUcraniaEmiratos Árabes UnidosReino UnidoEstados UnidosUnited States Minor Outlying IslandsUruguayUzbekistánVanuatuCiudad del VaticanoVenezuelaVietnamIslas Vírgenes, BritánicasIslas Vírgenes, EE.UU.Wallis and FutunaWestern SaharaYemenZambiaZimbabue Email de contacto 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 alcanzar Years in post (eg 2016 – 2021) enseñar Years in post (eg 2016 – 2021) durazno Years in post (eg 2016 – 2021) Comite de prevencion 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 Investigación Enseñando Other (please describe)Other (please describe) Poster Years (eg year of conference) Investigación 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. Suelte un archivo aquí o haga clic para cargar Elija el archivo Tamaño máximo de archivo: 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? * Sí No 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. Si eres humano, deja este campo en blanco. Entregar
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