Short Course Application form

Application Form
  1. Application Details
    1. I would like to attend the following course(s):
    2. Additional information
  2. Personal Data
    1. Please provide the following information about yourself.
  3. Professional background
    1. Please provide the following information about your professional background.
  4. Education
    1. Please provide information about your academic degrees - in chronological order.
  5. English language skills
    1. These short courses are held in English. Therefore, participants have to be proficient in spoken and written English.
  6. General Computer Skills
    1. General computer skills are crucial to follow these courses.
  7. Statement of Motivation
    1. Please provide a brief statement (max. 300 words) outlining why you would like to attend this course and what benefits you hope to gain from participating in it.
  8. Additional comments
    1. Any other information you wish to communicate to the organisers?
    1. You will find the privacy statement here.
    2. Please note if you have been offered a place on the course you will be asked to provide proof of your highest academic degree and you will be required to bring formal ID. If you are a tropEd student, you will also be required to provide a copy of your MScIH admission letter from your home institution and proof that you are currently enrolled in the MSc in International Health Programme (copy of your student ID or letter from your home institution).
  9. * These fields are required

  10. Send Application Form

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Dr Dewi Ismajani (Jani) Puradiredja

Department of Infectious Disease Epidemiology

Bernhard Nocht Institute for Tropical Medicine
Bernhard-Nocht-Str. 74
20359 Hamburg

Tel: +49 (0)40 428 18-243
Email: shortcourse(at)