Doctors Academy

  • A Not for Profit Organisation

    Grants and Bursaries

    Application Form
    1. Personal Details
    Title
    Gender
    Forename
    E.g., Anthony Mathew Jones (first name in bold)
    Middle name(s)
    E.g., Anthony Mathew Jones (middle name in bold)
    Surname
    E.g., Anthony Mathew Jones (last name in bold)
    Address
    Country
    Pin code/Post code/ Zip code
    Landline Number
    Mobile Number
    Email
    Please select the course for which this application is for:
    2.Your Professional Status
    I am a   Medical Student
      Doctor
    If you are a member of any of the the organisations listed here, then please enter your membership number or a code you might have to be considered for an additional exclusive place offered to these organisations:
    3. Specific Information
    I. Please list your contribution to medical education and training
     Contributions
    1
     
    II. Please list any voluntary and/or humanitarian activities where you have been previously involved or currently involved.
    (This could be regular support for charity, working in resource-poor settings, disaster management camps or any non-paid activity)
     Activities
    1
     
    III. Please submit a brief CV (abridged CV) in two pages or less.
    (Word 2003, 2007, 2010, 2013, 2016, pdf)
                            
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