Training in Research in Sexual Health - Geneva 2005

Application form

2005

FROM RESEARCH TO PRACTICE:

TRAINING IN SEXUAL HEALTH RESEARCH

Methodological Issues in Health Research
2 weeks

Sexual Health
3 weeks

Exams
1 week

14 February 2005 – 25 March 2005

organised by

the Fonds Universitaire Maurice Chalumeau
the Geneva Foundation for Medical Education and Research -
WHO Collaborating Centre in Education and Research in Human Reproduction,
the Department of Reproductive Health and Research (WHO/RHR),
the Association Inter Hospitalo-Universitaire de Sexologie (A.I.H.U.S)

in collaboration with

the Department of Health of the Canton of Geneva,
the Faculty of Medicine of the University of Geneva,
the Geneva Medical Association

COURSE CHOICE
I wish to apply to participate in the Course in Methodological Issues in Health Research; and Sexual Health Yes No
PERSONAL DATA
Family name
First names	female male
Maiden name
Date and place of birth
Nationality
Position held at present (state your activities and responsibilities)
Previous employments (last 4)
Family status
ADDRESS, TELEPHONE, FAX, E-MAIL
Professional address
Telephone number and Fax number with country and area codes
Personal address
Telephone number and Fax number with country and area codes
E-mail address (If you don't have one, you could get one at no cost at Yahoo.com or Hotmail.com)
LANGUAGE SKILLS

EDUCATION
University studies
University
Country
Faculty
Successful exams and year of graduation
Obtained university title and exact field
Academic certificates or diplomas and years when they were obtained
FINANCING
If you are accepted to the Course, please indicate, who will finance your participation in the Course	I will pay all costs myself I would like to apply for funding I have already found funding ...............they will pay all my costs .............. they will pay some of my costs ...............details (who/how-much/etc.)
ACCOMMODATION
If you are accepted to the Course, please indicate, if you would like the Course organisers to reserve a student's room for you in Geneva		Yes No
ENCLOSURES
Please attach the following documents: 1. curriculum vitae, including sections on: your current and previous positions; responsibilities in research, teaching and clinical work; the institution in which you work; and a list of publications (if available) 2. a certified copy of the diploma in medicine and any additional diplomas 3. a letter of motivation stating clearly your interests and reasons for applying to the Course (1 A 4 page maximum) 4. a 1-2 page summary of the research project/thesis that will be completed/written up as part of the exams 5. an official attestation confirming your proficiency in the English language 6. two letters of reference, preferably one form your current employer 7. if possible, please submit the following document: an introduction by your Head of Department stating your current role

Mother tongue
Other languages	Reading			Writing			Speaking
Other languages	Excellent	Good	Fair	Excellent	Good	Fair	Excellent	Good	Fair
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Please note that the lectures and exams will be held in English. Therefore, it is extremely important that your level of understanding, expressing yourself and writing in English is adequate.