Fellowship Application

The fellowship program is offered in English language only. Accepted candidates are expected to attend the sessions live via an identified platform. Applications are accepted from May 1st to July 1st, 2023. New cohort of fellows start the program in January 2024. Fellowship program consists of 12 sessions that run from January to December 2024.

"*" indicates required fields

Your Information

First Name*

Last Name*

Email Address*

Title

Current Occupation*

References

Reference 1

Full name*

Email Address*

Occupation*

Relationship to Candidate

Reference 2

Full name*

Email Address*

Occupation*

Relationship to Candidate

Attachments

You must have the following 5 documents ready to be able to submit your application. Each document must be a separate attachment. Name each file with the document number and your full name: Example: Document#1-Jane/JohnSmith

Document #1: Description of your current work responsibility - 100 words.
Document #2: Description of the patient safety problem you want to solve – 200 words.
Document #3: Up-to-date CV outlining your education and career to date.
Document #4: Letter of support from your employer indicating that they support your participation in the fellowship program.
Document #5: A personal statement to describe how you benefit form this fellowship program professionally and personally, how would this program benefit your region, what would you bring to the program, and what are your current and past experiences in patient safety and quality improvement field – 500 words.

Attach document

Drop files here or

Accepted file types: doc, docx, pdf, Max. file size: 10 MB, Max. files: 5.

If shortlisted, Patient Safety Movement Foundation has my permission to contact my referees?*

Yes

No

I confirm that the information on this application is true and correct to the best of my knowledge?*

Yes

No

Note: Once you submit your application you cannot change the information. Applications that are not complete or do not include the 5 required attachments will not be reviewed and considered.

Fellowship Application

Your Information

References

Reference 1

Reference 2

Attachments

10th Annual World Patient Safety, Science & Technology Summit