EADV - European Academy of Dermatology and Venereology - Scholarships

Online Scholarship & Grant Application Form

Please confirm that you have read and understood the criteria and conditions for application

Select Award Type*

	Michael Hornstein Memorial Scholarship (MHMS) For applicant(s) from geographic Central, Eastern, Northern and Western Europe
	John Stratigos Memorial Scholarship (JSMS) For applicant(s) from geographic Southern Europe and Mediterranean countries/region
	Imrich Sarkany Non-European Memorial Scholarship (ISNEMS) For applicants from the geographic 'Rest of the World' region
	IAD Grant (check for availability) For applicant(s) from Eastern Europe
	AAD Grant For applicant(s) from geographic Europe
	BSPD Grant For applicant(s) from geographic Eastern Europe
	SDS Grant For applicant(s) from geographic Eastern Europe

Last Name*

First Name*

Nationality*

Other

EADV Membership Number
(if available)

E-mail address*

Applicant address *

Street
Number
Postal Code
City
Country
	Home Address Work Address

Phone Number*

(incl. country code)

Home Phone Work Phone

Mobile Number

(incl. country code)

FAX Number

(incl. country code)

Birth Date

Day

Month

Year

Place of birth:

Choose your professional status in the field below, and fill out the remaining fields

Professional Status

Trainee/resident/registrar Specialist

For EADV membership eligibility only:

Trainee/Resident:

Yes No

European Dermato-Venereolgist:

Yes No

International Dermato-Venereolgist:

Yes No

Required documentation
Required Documentation in English to be submitted together & at the same time with completed application form, if possible. Upload your documentation in either word (*.doc, 1997-2003, *.docx), pdf, jpeg or power point format. Uploaded documentation shall not exceed 5MB.

Short CV and a list of publications (not more than 3 pages)

Letter of recommendation written either by training director or head of department/clinic, hospital endorsing the application

Letter of recommendation written by a 'Specialist' EADV member endorsing the application

A copy of your training or specialist certificate indicating start and end date

A copy of ID (identity card ie passport, the page which shows photo and spelling of name) and a passport size photograph)

TRAINEE / RESIDENT / REGISTRAR
Year of Training
Institution Name*
Name of training director

SPECIALIST
Year of Specialisation
Institution Name*
Name of head of department/hospital/clinic: