ICO Fellowships Program
Host Notice of Acceptance
ICO-Fred Hollows Foundation One-Year Subspecialty Fellowship
ICO-Retina Research Foundation Helmerich Fellowship
ICO Fellowship Program Host’s Notice of Acceptance A
First Name(s):
Male Female / Date of Birth: ,
Home Country:
Email:
Fellowship: / Proposed Period: / , to ,
Observership Clinical Exposure Surgical Exposure
Subspecialty:
Host Name:
Email:
Phone:
Fax:
Supervisor
Name:
Supervisor Email:
Training Center:
Street:
City, County:
I hereby accept the ICO International Fellowships Program Policies and confirm that I am willing to host the above-mentioned candidate. There are no arrangements with the candidate other than indicated above. I am familiar with his/her aims and I will help him/her achieve them within the one year training period. I declare that I will not charge any fees for providing the ICO Fellow with an excellent scientific and clinical training. I discussed possible language problems with the candidate. I will work to assure a positive experience for the fellow, both inside and outside the hospital.
______
Place and Date. Signature of Host. Name of Institution.
______
Date. Host’s Signature. Stamp of the Institution.
Please print and scan+email or fax this form both to the candidate and to the ICO Fellowship Board. Thank you!
Email: – Fax Number: +49-3212-3200120