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IAMP Young Physician Leaders 2013 “The Leadership Training Program & Network for Young Physicians”

IAMP Young Physician Leaders 2013

“The Leadership Training Program & Network  for Young Physicians”

NOMINATION FORM 2013

Deadline for receipt of nomination form  1 July 2013

CANDIDATE

 

 

Title (Prof/Dr. etc):

SURNAME(FAMILY NAME):

Name:

 

 

Date of birth:

 

 

Sex:

Current institution address

 

 

 

 

 

 

Tel:

 

Fax:

 

Email:

 

Field of specialization:

 

 

 

Academic qualifications  and Universities attended(begin with Bachelor's degree, then MD or (other medical degree? And residency or Fellowship training)- with dates):

  
 

Current employment and nature of responsibilities:

  



Reasons for the nomination (max. 200 words and based on requested criteria)

  
  

Provide evidence of current and past leadership and communication skills (no more than 200 words)
 
 
Provide evidence of engagement in “wider society”  (no more than 200 words)
 


 

Partial financial support may be available for candidates from least developed countries.

 

WILL THE CANDIDATE REQUIRE PARTIAL TRAVEL SUPPORT FROM IAMP?

 

 

NOMINATOR

Candidate nominated by:

IAMP member academy/M8 Alliance

Position of nominator  in IAMP Member Academy/M8 Alliance

Email address:

 

Additional supporting documents required:

v  Full CV and list of publications

v  Letter of Recommendation from President/Nominator of IAMP Member Academy

 Deadline for receipt of nomination form by email as a WORD attachment (iamp@twas.org)

1 July 2013

 

 IAMP Secretariat Contact

Ms. Muthoni Kareithi,

Tel: + 39 040 2240 681

Email: iamp@twas.org

 

 

 

  • Уншсан 3612
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MONGOLIAN MEDICAL SCIENCES
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2007-12-08-наас эхэлж 1047119 удаа хандсан.