Maghreb School application form

Eligibility
The School will consider applications according to the following criteria:
1) Experience in Paediatrics.
2) Special training in Paediatric Endocrinology
3) A proven interest in Paediatric Endocrinology
4) Competency in English language
5) Ability to attend the whole course
6) Ability to present a case scenario and/or research project in the school

PLEASE SUBMIT YOUR APPLICATION BY THE DEADLINE OF FRIDAY 15TH MAY 2020

Please ensure all mandatory sections marked with an asterisk (*) are filled correctly and in the format requested. Please do not submit more than one application.

ESPE Maghreb School 2020 Online Application Form

Section 1: Demographics

Name of applicant *

Full name

Date of birth *

Gender

Nationality *

Degrees *

(e.g MD, PhD etc.)

Present position and institution *

Work address *

Email *

Confirm email *

Telephone *

(International code/ National code/ Number)

Name of sponsor or head of department

Please fill even if not accompanied by a sponsor letter

Position and institution of sponsor or head of department

Please fill even if not accompanied by a sponsor letter

Sponsor or head of department email

Please fill even if not accompanied by a sponsor letter

Support letter

Optional signed support letter(s) from your head of department/supervisor etc. Please upload as PDF

Additional support letter (if required)

Please upload as a PDF

Section 2: English language abilities

Section 3: Education & Training

Undergraduate Medical degree *

University attended (Year of graduation)

Education history - Other degrees

Type of degree awarded (Year awarded)

Paediatric Training *

Please list posts in the following format: Job title, Institution, City, Time period (month/year – month/year)

Paediatric Endocrine Training *

Please list posts in the following format: Job title, Institution, City, Time period (month/year – month/year)

Other relevant Clinical Training e.g. General paediatrics or Adult Endocrinology

Please list posts in the following format: Job title, Institution, City, Time period (month/year – month/year)

Postgraduate courses attended

Name (Year attended)

Previous ESPE Schools attended

(Please detail which ESPE School(s) you have attended and which years)

Number of times previously applied for this School that you are currently applying for *

Research experience *

Yes

Please detail research experience

Please include topic and any post graduate degrees awarded

Section 4: Publications and Meetings attended

List of endocrine & related publications

Please only include full peer reviewed papers, not abstracts. Include full author list, title, year and journal. Please include papers where you are first author at the top of the list

List of non-endocrine related publications

Please only include full peer reviewed papers, not abstracts. Include full author list, title, year and journal. Please include papers where you are first author at the top of the list

List of all poster presentations presented at meetings

Please include your presentations as first author at the top of the list

List of all oral presentations presented at meetings

Please include your presentations as first author at the top of the list

International meetings attended

Name of meeting attended (Year it took place)

Section 5: Miscellaneous

Are you an ESPE member? *

Yes

ESPE membership number

Are you a member of any other society?

Please list the societies you are a current member of along with the relevant membership number

Consent, Assurance and Eligibility

Consent for storing submitted data *

I confirm that all the information given on this form is my own and is correct *

Head of department/Supervisor assurance *

By ticking this I hereby confirm that I have the assurance of my Head of Department/Supervisor who has agreed that the responsibility for my attendance, if accepted, lies with them

ESPE - European Society of Paediatric Endocrinology

In this section

Maghreb School application form

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