Apply for a Teacher Grant

Your Details

Saluation*
First Name
Last Name*
Email Address*
Gender*
Date of Birth*
DD slash MM slash YYYY
City*
Country*
Languages spoken fluently (must include language of centre being visited)*
Years since graduating medical school*
Please enter a number from 0 to 90.
Years training in ophthalmology*
Please enter a number from 0 to 90.
Please specify how many years you have been teaching residents and fellows*
Please enter a number from 0 to 90.
Duration of post-specialist experience*
Please enter a number from 0 to 90.
Where do you practice*

Your Hospital/Clinic Details

Hospital/Clinic you wish to visit (1)

Hospital/Clinic you wish to visit (2)

Duration

Past Applications

Have you applied for a grant previously
If so what year?
Please confirm you have not received a grant previously
I confirm I have not received a grant previously

Upload Your CV & Photo

Your CV*
Accepted file types: zip, doc, docx, txt, rtf, pdf, Max. file size: 50 MB.
Please submit a letter of recommendation from the Director or Leader of your department or centre
Accepted file types: zip, doc, docx, txt, rtf, pdf, Max. file size: 50 MB.
Your Photo
Accepted file types: jpg, jpeg, Max. file size: 50 MB.