WISE Application

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

Date of birth (must be under the age of 45 as at of February 28, 2022)*:

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 that you perform per year without supervision at the GI endoscopy unit where you are employed (only numerical)*:

Is the place of practice equipped with EUS System?*: Yes No

Candidate employed and practiced endoscopy since*: Total number of EUS procedures you have performed until now (only numerical)*: Total number of EUS Procedures performed independently by the candidate (only numerical):

Diagnostic EUS*: EUS-FNA*: EUS guided drainage*:

Total number of EGD procedures (only numerical)*:

Total number of CFS procedures (only numerical)*:

Total number of ERCP procedures (only numerical)*:

Number of peer-reviewed published papers during the last five years (only numerical)*: Level of English:*: Basic
Intermediate
Advanced
Native

WEO Individual Membership Only individual members of WEO are eligible to apply. Please insert the WEO individual membership number*:

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. Letter of recommendation from current employer (head of unit) including experience of the candidate and description of facilities. The current employer (head of unit) must also confirm in the letter that they will cover the candidate’s airfare/travel expenses for the Basic Anatomy workshop and both Module One and Two.*: 4. Documentation of proficiency in English (optional): 5. Peer-reviewed articles published during the last five years*: 6. 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.

All selected applicants must pay a deposit of USD500 to WEO in order to secure a training slot.
The deposit will be refunded in full to all applicants who participate in all FIVE online modules as well as the online EUS Summit 2022.
No partial deposit refund will be made.
Applicants are also responsible for the respective bank charges where applicable.
IMPORTANT: All applicants must submit a self-introductory 1-2 minute video introducing yourself and why you would like to join the WISE 2022 program. The video, named after your surname, should be uploaded as follows:
- http://www.webhard.net/
- ID: ASIANEUS2015
- Password: 1803
- Folder Name: Upload_Only -> WISE 2022

By submitting the application, the applicant agrees to comply with all the terms and conditions set by WEO with regards to the WEO International School of EUS (WISE) course 2022.
Terms and conditions are found on the WEO website.
WEO reserves the right to make any changes and/or amendments without any prior notice.

I agree to all the above terms and conditions stipulated by WEO with regards to the WISE 2022 program *

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

Submit Application