Home I Recherche I Fellowship I Application for a Fellowship "*" indicates required fields Step 1 of 4 - Applicant Information 0% FacebookThis field is for validation purposes and should be left unchanged.You are:* Mrs Mr First and last name* First name Last Name Marital status:* Married Single Date of Birth* MM slash DD slash YYYY Country of residence*Nationality*E-mail Address* Enter an email address Confirm email Phone*Education* Surgeon Gastroenterologist Radiologist Engineer Other If you checked “Other,” please complete this field.*Primary interest* Preclinical surgical research Preclinical endoscopic research Innovation/development of medical technologies Other If you checked “Other,” please complete this field.*University*Graduation year*Graduate* Yes No Degree* Current position*InstitutionLocationDates Add RemoveCurrent position (Title)*Medical Licensure, if applicableCountry/StateDate Issued Add RemoveProfessional address* Hospital / Clinic / Institute / Company Address City State / Province / Region Zip code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands - A cover letter (maximum 500 words) outlining their research interests and motivations for joining the Institute. - A concise CV with a complete list of publications - Three letters of recommendationPlease upload your resume, cover letter, and three letters of recommendation.* Drop files here or Select files Accepted file types: pdf, jpg, Max. file size: 2 GB. If you are having trouble reducing the size of your file, you can use online tools such as smallpdf.com. Desired start date* MM slash DD slash YYYY Research project summary (Abstract)*Please present your personal project concisely. Your abstract should include the context, objectives, proposed methodology, and potential impact in the biomedical field. 300 words maximum. Project appendix(es)Please upload any documents that may be useful for evaluating your project (technical diagrams, preliminary data, or bibliography) here. PDF only. Drop files here or Select files Accepted file types: pdf, jpg, Max. file size: 2 GB. Key questions and research plan*Detail the context, objectives, and methods. 300 words maximum.English* Read Spoken Written French* Read Spoken Written Is financing possible?* Yes No Type of interview desired* Videoconference On-site (Strasbourg) How did you hear about the IHU Strasbourg?*Social mediaGoogleWord of mouthPast FellowsBrochureOtherComment(s)GDPR* I certify that I have read and understood the terms and conditions and the privacy policy.The collection of above information is necessary to process your request. The collected data is for the exclusive use of the Institute of Image-Guided Surgery (IHU Strasbourg) and will under no circumstances be communicated to third parties.The data communicated in the context of your form is processed by the IHU of Strasbourg for the needs of the management of the pre-registrations. To learn more about how we manage your personal data or to exercise your rights, please visit our Privacy Policy. . Δ
