Apply for a Scholarship Part II Sponsor - International Academy of Aviation and Space Medicine

Scholarship Application Form

PART II - TO BE COMPLETED BY SPONSOR

You have been asked to act as a sponsor for a doctor who wishes to apply for a grant to cover tuition costs for training in Aviation and Space Medicine.

As a sponsor you should be a physician who has experience in aviation and space medicine and who has knowledge of the applicant, including their professional interests.

Please complete the following form and submit it to the Academy by the 31st July of the year in which the grant application is being submitted.

NOTE: All fields are required. If not applicable, so state.

Name of scholarship applicant(*)

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Year of scholarship application(*)

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Sponsor Details

Your title(*)

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Your full name including post-nominals(*)

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Phone number including country code(*)

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E-mail(*)

Invalid email address.

Current role and employment/occupation(*)

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Correspondence address(*)

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Are you a member of IAASM - The International Academy of Aviation and Space Medicine? (*)

YesNo

Please check the right answer.

Do you have any conflict of interest in acting as a sponsor for the applicant? Yes/No If yes, please describe.(*)

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Recommendation for scholarship grant.
Describe how you know the applicant, for what time period you have known them and your view as to their suitability to be awarded a scholarship grant(*)

This field is required.

Thank you for your willingness to act as a sponsor by providing your recommendation to the International Academy of Aviation and Space Medicine.

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