Application form

Application Form
  1. Personal Data
    1. Please provide the following information about yourself.
  2. Professional background
    1. Please provide the following information about your professional background.
  3. Education
    1. Please provide information about your academic background - starting with your highest academic degree.
  4. English language skills
    1. This short course is held in English. Therefore, participants have to be proficient in spoken and written English.
  5. Academic degrees
    1. Please upload a scanned copy of your highest academic degree certificate as one pdf-file (name the file as follows: 'Surname_Degree'). If this document is not in English or German, we require a certified translation.
  6. Copy of your passport
    1. Please upload a scanned copy of the main page of your passport as one pdf-file (please name the file as follows: ('Surname_Passport').
  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?
  9. Send Application Form

COURSE DETAILS

Course dates

3-21Sept 2018

Course fee

800 € - 1750 €

Application deadline

30 April 2018

This course is formally recognised by the Hamburg State Medical Chamber.
Dieser Kurs ist von der Ärztekammer Hamburg anerkannt. 

Contact

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)bnitm.de