MENTORSHIP PROGRAM

for Women in Endoscopy

April – November 2024 | 🌐 HYBRID

Application form

Name(Required)

First Last

Day(Required)

Month(Required)

Year(Required)

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)

Fluency in English (from A1 to C2)(Required)

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.

By ticking this box, I confirm that I will make my own transportation arrangements for the onsite meetings.

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

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.