/ Fondation pour le Développement de la Médecine Interne en Europe
Stiftung für die Förderung der Inneren Medizin in Europa
Foundation for the Development of Internal Medicine in Europe /
Winter2017

EUROPEANSCHOOL OF INTERNAL MEDICINE – WINTER SCHOOL 2017

Venue:Astor Riga Hotel, Riga, Latvia

Course dates: Monday 6 February to Friday 10 February 2017

(Residents Arrive: Sunday5 February; Residents Depart: Saturday 11 February)

ESIM-FDIME BURSARY APPLICATION FORM

(Closing Date: 11.11.2016)

A limited number of bursaries are available to enable Young Internists from low-income EFIM Member Countries to attend the EuropeanSchool of Internal Medicine.

The funding is provided by the Foundation for the Development of Internal Medicine in Europe (FDIME) specifically intended for YIs from EFIM-affiliated member countries that are currently experiencing financial hardship.

Applicants must meet the following criteria:-

  • Come from an EFIM member country and provide a letter of support from their National Society
  • Be able to communicate in English (this is essential: all lectures & interaction is in English)
  • Be towards the end of their training in Internal Medicine and under the age of 36 years.

Type (or print clearly) your details below and read the ‘Additional Important Information’ on page 2.

Send completed form, CV, letter of support to: Mrs Janet Stevens e-mail:

FAMILY NAME:
1ST Name(s):
Postal Address:
Country:
Date of Birth:
Nationality:
Gender (Male/Female):
E-mail address 1:
E-mail address 2:
Mobile Telephone:
What is your field of interest/subspecialty?
Where do you practice (hospital/university/private)?

Free Motivation Statement (approx 150 words)

(Please indicate the reasons why you think this course will be valuable to you)

Name of Applicant:
Current Year of I.M. Residency:

Documentsrequired to be submitted with this application:

  • Your current and up-to-date CV (include any publications)
  • A Letter of Support from your National Society of Internal Medicineincluding a statementto indicate if the National Society is able to support travel expensesto the ESIM-host country. (see 2 below)

Additional Important Information:

  1. The ESIM-FDIME bursary covers the cost of the ESIM Registration Fee (995.00 Euros) which will include the following: accommodation for 6 nights, all meals, school facilities, internet access, educational materials and various social activities.
  1. It is expected that National Society of Internal Medicine who proposes The Applicant will support theeconomy-rate travel expenses to ESIM. The Letter of Support from the National Society must state whether or not travelfunding will be provided.
  1. Successful applicants are responsible for making their own travelbooking, for checking their passport validity, obtaining avisa (if applicable), and arranging Travel insurance.
  1. Candidates who are selected to attend ESIMare required to prepare and present a 10 minute clinical case study with accompanying Powerpoint slides.
  1. A 200 – 300 word report written in English will be required from the successful applicants within one month after attending ESIM.
  1. All bursary applications will by assessed by the FDIME-ESIM Bursary Selection Committee who will award the sponsorship. Successful candidates will receive a Letter of Acceptance from the FDIME President. The bursary funding will be paid directly to ESIM, not to the candidate.

Return to: Mrs Janet Stevens, FDIME-ESIM Bursary Administrator. E-mail:

Page 1 of 2