CHINESE TAIPEI PEDIATRIC ASSOCIATION

TRAVELLING FELLOWSHIP

The Chinese Taipei Pediatric Association would like to offer an annual one year Pediatric Research and Training Fellowship for paediatricians nominated by the APSSEAR national pediatric societies.

The Fellowship to be offered at present is obtainable in the fields of Cardiology, Neonatology, or Hematology/Oncology. The candidate must be less than 40 years old and be able to have a good understanding of English.

The candidate may choose a medical school or hospital in Taiwan.

Applications to be forwarded to the Secretary of the member society of APSSEAR in the country of residence of the applicant.

Each member society of APSSEAR may forward one application to the Secretary-General of APSSEAR who will forward the applications from all member societies to the Chinese Taipei Pediatric Association..

The value of the Fellowship will vary, the maximum award being determined from time to time by the Chinese Taipei Pediatric Association.

The Fellowship is expected to cover an economy round trip air ticket between the country of origin of the nominee and Taiwan plus a monthly stipend. The Chinese Taipei Pediatric Association will help the nominee find a place for accommodation.

The offer of this fellowship is made through the Secretariat of the Association of Paediatric Societies of the Southeast Asian Region. For each year, only one candidate is considered per country. The final decision for awarding the Fellowship is with the Chinese Taipei Pediatric Association.

Applications will be considered if typed on the application form and accompanied by a full curriculum vitae.

Chinese Taipei Pediatric Association

APPLICATION FORM FOR APSSEAR TRAVELLING FELLOWSHIP

(Please enclose a detailed curriculum vitae and complete all sections)

1. SURNAME: ……………………………………………………………………………………….

GIVEN NAMES: ………………………………………………………………………………….

2. MALE FEMALE 3. DATE OF BIRTH

DAY ____ MTH ____ YR _______

4. COUNTRY OF 5. NATIONALITY:

BIRTH: ____________________ ______________________________

6. MARITAL STATUS MARRIED SINGLE

7. HOME ADDRESS: ……………………………………………………………………………..

……………………………………………………………………………..

8. PROFESSIONAL ……………………………………………………………………………..

ADDRESS:

……………………………………………………………………………..

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9. ACADEMIC QUALIFICATIONS

DEGREE

CONFERRING

INSTITUTION

YEAR

CONFERRED

UNDERGRADUATE

POSTGRADUATE

10. POSTGRADUATE APPOINTMENTS (Detail all appointments held)

Previous Position Held

HOSPITAL/

UNIVERSITY

POSITION

COMMENCEMENT

DATE

FINISING

DATE

LENGTH OF

APPOINTMENT

Present Appointments

HOSPITAL /

UNIVERSITY

POSITION

DATE

COMMENCED

11. SCIENTIFIC PUBLICATIONS (If insufficient space, attach list)

………………………………………………………………………………………………….

12. FIELD WHICH YOU WISH TO STUDY

………………………………………………………………………………………………….

13. CENTRE(S) WHERE STUDY WILL BE UNDERTAKEN (If Known)

………………………………………………………………………………………………….

14. WHO WILL SUPERVISE WORK? (If known) Indicate if they have agreed in

writing.

………………………………………………………………………………………………….

15. AIMS OF TRAVEL TO TAIWAN (Include details of course of study, position to be

held or details of research projects if any of these are known)

………………………………………………………………………………………………….

16. HAS APPLICATION BEEN MADE FOR ANY OTHER FINANCIAL SUPPORT FOR THE

STUDY PERIOD?

………………………………………………………………………………………………….

17. WHAT DO YOU SEE AS THE BENEFIT TO PAEDIATRICS IN YOUR COUNTRY

OF ORIGIN ARISING FROM YOUR STUDY IN TAIWAN?

………………………………………………………………………………………………….

18. WHAT FORMAL TRAINING AND EXPERIENCE DO YOU HAVE WITH

ENGLISH?

Reading: ………………………………………………………………………………………

…………………………………………………………………………………………………

Spoken: ………………………………………………………………………………………

…………………………………………………………………………………………………

19. DO YOU INTEND TO STAY LONGER THAN ONE YEAR STAY

PROVIDED FOR BY THE FELLOWSHIP?

………………………………………………………………………………………………….

20. NAMES AND ADDRESSES OF THREE (3) REFEREES

(i) .…………………………………………………………………………………………….

………………………………………………………………………………………………….

(ii) .…………………………………………………………………………………………….

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(iii) …………………………………………………………………………………………….

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REFEREES FORM

CHINESE TAIPEI PEDIATRIC ASSOCIATION

APSSEAR TRAVELLING FELLOWSHIP

NAME OF THE CANDIDATE: …………………………………………………………….

REFEREES STATEMENT

(i) Please comment in detail on this candidate’s ability to communicate in English.

………………………………………………………………………………………………….

(ii) Do you regard the proposed study as appropriate to the candidate and your country’s
requirements?

………………………………………………………………………………………………….

(iii) What are the prospects for the candidate utilizing his experience on return to his own

country?

………………………………………………………………………………………………….

GENERAL STATEMENT AND COMMENTS ABOUT CANDIDATE

(Use separate sheet if necessary)

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