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Application Form for Courses offered in Obstetric Ultrasound and Fetal Medicine
All * are mandatory fields
*
1.
Course Opted for / interested in:
(Required.)
ONE YEAR - FELLOWSHIP IN OBSTETRIC ULTRASOUND (Full Time) under AEGIS of Fernandez FoundationEligibility: MD/DGO/MS/DNB/Radiology in the concerned specialty from MCI recognized institutes.Age not exceeding 45 years of the year of admissionSelection - Entrance Exam and InterviewStipend : Not Paid
TWO YEAR FELLOWSHIP IN FETAL MEDICINE (Full Time) under AEGIS of Fernandez FoundationEligibility: MD/MS/DNB in Obstetrics and Gynecology in the concerned specialty from MCI recognized institutes.Age not exceeding 45 years of the year of admissionSelection : Entrance Exam and InterviewStipend : Paid
*
2.
Details
(Required.)
Name
Date of Birth
Age
Gender
Address 1
Address 2
City
State
Mobile 1
Mobile 2
Email
*
3.
Specialty
(Required.)
Obstetrics & Gynaecology
Radiology
Others
*
4.
Qualification
(Required.)
MD - OBGY
MS - OBGY
DNB - OBGY
DGO - OBGY
MD - Radiology
DNB - Radiology
DMRD
*
5.
University
(Required.)
*
6.
Year of Passing
(Required.)
*
7.
Percentage/GPA
(Required.)
*
8.
Remarks (If any)
(Required.)
*
9.
Experience
(Required.)
Yes
No
If Yes please mention years of experience.
*
10.
Research Work
(Required.)
Awards
Papers presented
Papers published
*
11.
Describe in a few lines your present scope of work.
(Required.)
