1st SYMPTOMA, better diagnosis Scholarship

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Email *

First name, last name: *

Email: *

Date of birth: *

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Country of origin: *

Country of study: *

Subject of study (human medicine, dentistry, veterinary medicine or other=describe in detail): *

Which higher educational institution are you attending? *

Expected to be completed during the calendar year: *

How many hours a week do you study? *

How many hours a week do you work while studying? *

What are you working? *

What do you currently earn per month? (USD) *

How much do you spend per month? (USD) *

What is SYMPTOMA? What problem does it address? (Max. 5 sentences!) *

If applicable, why would you recommend SYMPTOMA? Why is it useful, in your opinion? (Max. 5 sentences!) *

Why do you need this scholarship? (Max. 5 sentences!) *

The sender hereby expressly agrees that all personal data disclosed in this questionnaire will be stored in Google Forms and also sent to Symptoma GmbH for the award of the scholarship. Symptoma GmbH will only store this data for as long as necessary to complete the scholarship evaluation, and then delete it. The data of the winners will be stored according to the legal retention period. This consent can be revoked at any time.

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