Emerging Stars Application

Personal Information Title*: Surname*: First name*:

Date of birth (must be under the age of 45 as at February 28, 2021)*:

Gender*: Female Male

Contact Information Address line*: Additional address line: Additional address line: Additional address line:

ZIP code:

City*:

Country*: Telephone*: Mobile number*: Email*:

Education College/University*: Degree (with year of graduation)*:

Employment Place of employment*:

Type*: Private practice
Public hospital
Academic hospital
Other

Position at the place of employment*: Number of staff at the GI endoscopy unit where you are employed (only numerical): Number of endoscopic procedures performed per year at the GI endoscopy unit where you are employed (only numerical): Candidate employed and practiced endoscopy since*: Field of interest: Teaching position:: Options:

a. Current faculty position responsible for teaching of GI fellows
b. Current non-faculty position responsible for teaching of GI fellows
c. No current teaching position but with desire/potential for teaching
d. No current teaching position without desire/potential for teaching

Number of peer-reviewed published papers (indexed in pubmed) (only numerical): Level of English:*: Basic
Intermediate
Advanced
Native Member of scientific societies*:

Documentation

Please include the following documentation in electronic format only (MS Word or PDF format, maximum file size: 1.5Mb).
Be sure to upload the document to be attached before submitting your application.

1. CV (listing any publications at the foot of the CV)*: 2. Certification that the applicant is qualified in endoscopy*: 3. Reference from current employer*: 4. Documentation of proficiency in English (optional): 5. Additional documentation (optional): 7. Photo (optional):

Fields marked * must be filled in.

On submitting the form, please be aware that uploading large files can take several minutes.
To reduce such delays we suggest that you keep the size of your documents as small as possible.

I agree to all the above terms and conditions stipulated by WEO with regards to the Emerging Stars program *

For any questions, please write to secretariat@worldendo.org

Submit Application