MENTORSHIP PROGRAM for Women in Endoscopy April 2025 – February 2026 | 🌐 HYBRID Application form Name(Required) First Last Day(Required)– Select – 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month(Required)– Select – January February March April May June July August September October November December Year(Required)– Select – 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 Email Address(Required) Current Hospital Institution(Required) Address of Institution(Required) Country(Required) What is your current position?(Required) What are your specialties in the endoscopic field?(Required) Years of practice in interventional endoscopy(Required)– Select – 1 2 3 4 5 6 7 8 9 10 10+ Fluency in English (from A1 to C2)(Required) A1 A2 B1 B2 C1 C2 What is your highest priority as per the program content?(Required) Have you taken part in another mentoring program already? If yes, please specify(Required) Eventual limitations (please specify time constraints, traveling issues, and anything else that may be relevant as per the program characteristics)(Required) Upload section ID or Passport(Required) Max. file size: 16 MB. Up-to-date resume(Required) Max. file size: 16 MB. Cover letter(Required) Max. file size: 16 MB. Recommendation letter (from a former or current supervisor or Head of Institute/Department)(Required) Max. file size: 16 MB. (Required) By ticking this box, I confirm that I will make my own transportation arrangements for the onsite meetings. (Required) By ticking this box, I confirm that I am able to fully commit to the program with its online and onsite activities during its whole duration (Required) The program organizers will process the applicant’s personal data as provided in the application dossier. The applicant gives their consent to such control and processing of their personal data. You can withdraw your consent for data processing at any time. To request the deletion of your data, please contact us at [email protected] The program organizers will handle the applicant’s personal data in accordance with all applicable legislation for the purpose of reviewing the candidate’s suitability for the Mentorship.
