DJCFP Application
Application form to the Donald J Cohen Fellowship Program - IACAPAP Prague 2018
Please provide your demographic and contact information
LAST NAME
Your answer
Date of birth
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DD
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YYYY
Country of Residence
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GENDER
FIRST NAME
Your answer
email address
Your answer
Please specify your university, health center, or academic affiliation:
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What is your professional background?
Required
What is your current position?
Required
Country of Origin
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Have you ever received travel award support from ESCAP, IACAPAP, AACAP or other organization?
Required
if you answered yes, please specify
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Updated Curriculum Vitae
6. Please include the top items from your CV in the space below. Be clear, but brief about your accomplishments (clinical work, actions for the community, research, teaching, leadership) (maximum of 15 items or 700 words)
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National or Regional Organizational Support
7. Are you affiliated with any national or regional association recognized by ESCAP or IACAPAP?
Required
If you answered yes, please specify:
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If you are part of an organization, can that organization support your application?
Please note that formal nomination or support from a local or regional organization is not required of applicants. However, such support would certainly be welcome and provide additional information to be considered in the selection process
Required
Personal Essay
9. Please provide a brief personal essay (no longer than 700 words) addressing the following: A. A brief reflection on your leadership skills describing a leadership initiative you took. B. How you envision your current and future role and contributions to child and adolescent psychiatry in your country? B. How will your attendance at the Prague Congress and its mentorship program help you reach those goals?
Your answer
Please send your recommendation letter to the following email address naoufel2.gaddour@gmail.com
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