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To apply for a Bursary from the British Division of the International Academy of Pathology, print this web page out. Fill in the form legibly, preferably with a typewriter, and post it to:

Dr Nafisa Wilkinson, c/o Mrs Carol Harris, Po Box 73, Westbury-on-Trym, Bristol BS9 1RY, UK.

Or fax the form to: (+44) (0) 117 907 7941


Application Form

Your name:

Your address (For correspondence):

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Your address (Place of work, if different from the above):

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Your e-mail address:

Medical qualifications:

Date of medical qualifications:

Your date of birth:

Your present age:

Information about your laboratory

Population served by your laboratory:

Total number of histopathology specimens per year:

Total number of autopsies per year:

Number of full-time equivalent histopathologists (NOT trainees):

Information about your proposed trip

Meeting you wish to attend:

You should have arranged to visit a laboratory while you are in the area of the British Division? Please give details, including a contact name and address.

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What is the return fare (Economy) in Pounds Sterling
between your nearest airport and an appropriate airport in the area of the British Division?

 

Please give the names, postal addresses and (if available) email afddresses of two pathologists, one of whom should be your Head of Department, who are willing to support your application with a reference.

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Give a BRIEF summary of your training so far, and your future plans.

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Explain briefly how this experience would benefit your institution and the population it serves.

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We regret that it may not be possible to acknowledge receipt of applications. Successful applicants will be informed by post.