Email the completed application form, along with your recent CV (resume), to to with “” and copy the subject line Fellowship application from Indian Association of Preventive and Social medicine (IAPSM). Name: ___________________________________ Age: _____________________ Gender: ________ Medical Council of India /State Medical Council registration number: ______________ Name of State Council: __________________ Complete postal address: Plot No. ____________________________________ Street/ Area: ____________________________________ City & State: ____________________________________ Pin Code: ____________________________________ Email id: Phone number: Relevant qualifications: Relevant Experiences: Please write why do you want to apply for the Fellowship (in 500 words) Please write what would you want to do after the Fellowship (in 500 words) Place: _____________ Date: __ __ / __ __/ __ __ Last date for submission : 31st May 2017
Email the completed application form, along with your recent CV (resume), to “” and copy to with the subject line Fellowship application from Indian Association of Preventive and Social medicine (IAPSM). Name: ___________________________________ Age: _____________________ Gender: ________ Medical Council of India /State Medical Council registration number: ______________ Name of State Council: __________________ Complete postal address: Plot No. ____________________________________ Street/ Area: ____________________________________ City & State: ____________________________________ Pin Code: ____________________________________ Email id: Phone number: Relevant qualifications: Relevant Experiences: Please write why do you want to apply for the Fellowship (in 500 words) Please write what would you want to do after the Fellowship (in 500 words) Place: _____________ Date: __ __ / __ __/ __ __ Last date for submission : 31st May 2017
FINCH_Application_Form_2017-18.docx