Test Formular

Registration GIBACHT

Personal data

Title

First Name *

Surname (as stated in passport) *

E-Mail-Address *

Address of residence *

Post code *

City *

Country of residence *

Phone number (including country code) *

Date of birth (DD-MM-YYYY) *

Nationality *

Gender *Gender

Professional experience

Please detail your professional experience of at least two years in either the public health or medical sector, preferably with engagement in the management, prevention and control of infectious diseases.

Name of Current Employer/Institution *

Faculty, Department

Address of the Employer/Institution (Street, Post Box, ZIP Code, City, Country) *

Your Position at the Employer/Institution (example: clinician/researchers/lecturer) *

Your tasks (not more than 120 characters)

Duration of employment (MM/YY-MM/YY)

Education

Please indicate your degree or proficiency in at least one of the following fields *

if you ticked ‘equivalent life science discipline', please specify...

Please provide information about your academic background - starting with your highest academic degree

Degree 1 *

Field of study *

Name of institution *

Duration of study (MM/YY – MM/YY) *

Title of thesis (if applicable)

Degree 2

Field of study

Name of institution

Duration of study (MM/YY – MM/YY)

Title of thesis (if applicable)

Degree 3

Name of institution

Field of study

Duration of study (MM/YY – MM/YY)

Title of thesis (if applicable)

In case of your acceptance to the programme, we will require scanned copies of your highest academic degree confirming your eligibility as one PDF file. If these documents are not in English, we require a certified translation.

Language skills

The course is held in English. Therefore, please indicate your level of English language proficiency:

Reading *

Writing *

Speaking *

Motivation letter

In your motivation letter, please specify why you want to attend the programme, what benefits your institution/country can gain from the programme, what skills you will bring to the programme, and how you will act as a potential multiplier to spread what you have learned. Please also indicate whether you have experience in teaching and training.
Please submit a motivation letter (maximum length 500 words) in one PDF file (name the file as follows: ‘Surname_Motivation letter’).

Motivation letter *

Proof of English Proficiency

Advanced proficiency in English is required for all participants, for example: TOEFL Paper 550, TOEFL Computer 213, TOEFL Internet 79–80, IELTS 6.0, native speaker, or completed higher education in English (with written proof). Please submit any proof of your English language proficiency as one PDF file (please name the file as follows: Surname_Proof of English proficiency).

For applicants without proof of English proficiency, we intend to conduct phone interviews.

Proof of proficiency

Endorsement document of current employer

An endorsement document of the current employer confirming a minimum of a one-year contract duration following completion of the programme is required. This endorsement should include an assurance that the GIBACHT fellow will be released from work for the three one-week workshops.
We ask you to download the template for the endorsement document (link to form) and submit the completed document as one PDF file (please name the file as follows: Surname_Endorsement document).

Endorsment *

How did you hear about us?

Through which channel did your hear about us? *

If you selected ‘Other institution’, please specify...

Data Protection Policy

I have read and understood the data protection policy (see below) and agree to it. *

I have read and understood the ‘Consent form’ (see below) and agree to the ‘international data transfer’. *

I have read and understood the ‘Photo- and video recordings and interviews consent form’ (see below) and agree to it (optional).

Send

After filling in the form please check your data and press "Submit". You will receive a confirmation email with your registration information.
Should you get an error message, please check your entered data in the marked fields.
Should you have any questions, please send an email to gibacht@bnitm.de.

consent-to-create-use-and-publish-your-photo-and-video-recordings-and-interviews.pdf ( PDF 209 KB )
consent-to-data-transfer-outside-the-european-union-eu-or-theeuropean-economic-area-eea.pdf ( PDF 75 KB )
data-privacy-notice_gibacht.pdf ( PDF 172 KB )

Kontakt

Bernhard-Nocht-Institut für Tropenmedizin

Registration GIBACHT