Ictus Fellowship Application Form

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General Information

** Please Note: For an application to be considered, every field is required. **
** Also Note: Every time you save your application don't forget to enter your email adress and write down the new link as the old links will no longer work. **
Name First Last
Preferred First Name (if different from name above)
For which training program are you applying?

For which training program are you applying? Three months at the University of Washington Master's in Clinical Epidemiology at the Universidad Peruana Cayetano Heredia Master's of Public Health at the University of Washington
Email
Alternate Email
Research Experience
If you have had formal research experience (i.e. participated in design, implementation, or analysis of a clinical or laboratory research project) please list the institution, laboratory and mentor, and describe the project and your role in it. Please confine your answer to no more than 300 words.
Maximum of 300 words allowed. Currently Entered: 0 words.
Personal Statement
Please state why you are interested in this program, what you expect to gain from this experience, and what you can offer this program. Please confine your answer to no more than 500 words.
Maximum of 500 words allowed. Currently Entered: 0 words.
Research Plan
Please list your major areas of research interest within cerebrovascular diseases or rehabilitation medicine Character limit of 40.
Maximum of 40 characters allowed. Currently Entered: 0 characters.
List any potential mentors. Please include their name, institution, and their area of expertise.
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Enter Your Email Address *

A special link to resume the form will be sent to your email address.

Ictus Fellowship Application Form

Ictus Fellowship Application Form

General Information

Research Experience

Personal Statement

Research Plan