ECFS Clinical Fellowship Application Form

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The ECFS has partnered with the course ‘Managing the care of children and adults with cystic fibrosis’ held twice a year in London, UK or on-line, www.cfcourse.co.uk [1], to offer clinical placements to members of the CF multidisciplinary team.

Sponsorship includes free attendance at the course in London or participation in the on-line course, followed by a two week placement at the Royal Brompton Hospital (paediatric or adult departments). Travel and accommodation will be covered.

The course is held twice a year in March and September, the on-line course can be done at any time.

www.cfcourse.co.uk [1]

Before completing this form, please read the ECFS Clinical Fellowships Terms of Reference (https://www.ecfs.eu/society-details/short-term-fellowships [2]), and specifically please note the requirement to submit:

Your CV
A letter from your Institution/PI supporting the action

Please only submit files with a .gif, .jpg, .png, .doc, or docx extension - no other file types will be accepted.

Please complete all the sections below.

1. Applicant's Information

Your Organisation/Institution *

Your First and Last Name *

Date of Birth *

Day

Month

Year

ECFS Membership Number *

Job Title *

Department *

Street Address *

Town/City *

Postal Code *

Country *

Telephone Number *

Please include the country code

Email *

2. Activity Information

Please provide your preferred course format *

Live course in London

Online Course

Preferred Dates for Clinical Fellowship

From *

Day

Month

Year

To *

Day

Month

Year

Provide a statement on the beneficial impact the Fellowship will bring to your CF Centre *

3. Funding Information

I confirm that the same funding support requested in the this aGrant Application will not be sought from another source *

Confirm

4. Acknowledgment Information

All the information submitted in connection with this activity is compliant with the ECFS Clinical Fellowships Terms of Reference *

Confirm

The ECFS reserves the right to publish grant information on the ECFS website and to report the information to the ECFS Membership *

Confirm

5. Files to send

Applicant's CV *

More information

Files must be less than 20 MB.
Allowed file types: gif jpg jpeg png pdf doc docx.

Letter from your Institution/Principal Investigator supporting the action

More information

Files must be less than 800 KB.
Allowed file types: gif jpg jpeg png pdf doc docx.