Maria Duran Fellowship Application

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2019 Maria Duran Fellowship Application

To honor the memory of Maria M. Duran, MD, former Secretary-General and Executive Vice-President of the International Society of Dermatology, the Maria M. Duran Committee wishes to recognize potential future female leaders in international dermatology by awarding the Maria Duran Fellowship. One to two fellowships of up to US $1000 (if two are awarded) or $2000 (for one award) each year to attend an ISD meeting where she will present a poster or oral presentation.

The awardees will be require to present a short summary of their abstract at the ISD Sister Society Session on June 10, 2019 (8:30 AM - 12:30 PM) during the WCD.

Meeting: World Congress of Dermatology
Place: Milan, Italy
Dates: June 10-15, 2019

Deadline for Applications

• November 1, 2018

ELIGIBILITY

Female residents in dermatology or within one year of training completion/board examinations.
Preference will be given to those from third world countries.
Preference will be given to those living closer to the location of the ISD meeting.
A Letter of recommendation from the Chair of the applicant’s training program and a letter from the applicant's local/ regional/national dermatologic society.
Preference given to those under the Age of 35 years at the time of the meeting (copy of passport)
Proficiency in English to deliver presentation at the meeting (date and time to be determined).
Agreement to prepare a report for the ISD Connection Newsletter about the meeting she attended.
Applicants must prepare a budget for submission with the application.

INSTRUCTIONS

You must submit an abstract with your application.
An application that includes a copy of the abstract, must be completed below.
Letter of endorsement.
Description of why you would like to attend the meeting.
Brief budget.
Brief biography (not a complete CV).
Deadline is November 1, 2018.

Please complete the form below:

First Name *

Last Name *

Address *

City *

State/Province (if applicable)

Zip/ Postcode (if applicable)

Country *

Telephone *

Fax

Email *

Gender *

Date of Birth (Please spell month) *

Please upload proof of age from your passport including photo.

Age on January 1st *

Medical School Attended: *

Year of Graduation *

Dermatology Residency Program: *

Years of Training: *

Dermatology Board Examination (year completed or anticipated) *

Please list any dermatology fellowships you have received:
(Maximum characters: 2000)
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Higher Degree, if any:

Please list any regional/international meetings you have attended in the last three years.
(Maximum characters: 2000)
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Publications, if any:
(Maximum characters: 2000)
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Chair of Dermatology Department where you trained/are training or are currently working *

Department Chair's Email

Please upload a letter of support from your Dermatology Department. Submit as MS Word or PDF file only.

Name of Society submitting reference on your behalf. *

Please upload the letter from your national or local society.

Personal Statement about why you think this fellowship will benefit you and what you might present at the meeting. Include 1) a short budget 2) a short biosketch of yourself. Limit of 2000 characters. *
(Maximum characters: 2000)
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Abstract Title: *

Please type (or cut and paste) your abstract below. Limit of 2000 characters. *
(Maximum characters: 2000)
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Maria Duran Fellowship Application

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