Application Form

About us
News
How to apply
Fellowship opportunities
Support us
Contact us

About us
News
How to apply
Fellowship opportunities
Support us
Contact us

Please complete this form to start the process of applying for the Victoria Cohen scholarship for aspiring ocular oncologists. We will contact you for more information in due course.

Name

University name

Graduation year

Academic degrees

Ophthalmic training program location

Year of completion

Have you already done a fellowship in ocular oncology?

Yes No

Have you already done a fellowship in another ophthalmic sub-speciality?

Yes No

Current working place and position

Previous work experience in ophthalmology

Country and site of the fellowship

Duration of the fellowship

Type of fellowship

Clinical Clinical research Research only

Have you attained preliminary acceptance for the fellowship?

Yes No

What sources of funding have you secured for the fellowship?

Do you require a medical licence in the country of the fellowship?

Yes No

When will you obtain the required licence?

After we receive your submission, we will contact you by e-mail to let you know the status of your application.
If you are shortlisted we will ask you to provide the following:

A CV including a list of publications.
A letter from the fellowship supervisor indicating your preliminary acceptance, tentative fellowship dates, and plan.
A letter or reference that comments on how your fellowship will benefit ocular oncology clinical care or research endeavours in your country.
A one-page personal statement, outlining your prior experience in ophthalmology and ocular oncology, your reasons for pursuing the fellowship, and your long term plans.

Please do not send any of these until we ask you to do so.

I have reviewed my responses and the next steps above, and I would like to apply for this award.

I have read and accept the Privacy Policy

I confirm that the above statement is true