Desired Duration : 6 months / 1 year

Starting Month : March / Others (

Wooridul Spine Hospital

Fellowship Program Application Form
1. Personal Information
Name
Address
Phone Number
Fax Number
E-mail
Date of Birth
Place of Birth
Citizenship
First Language
Marital Status

2. Business Address
Hospital
Address
Phone Number
Fax Number
E-mail

3. Parents, Next of Kin or Other Alternate Contact

Hospital
Address
Phone Number
Fax Number
E-mail

Application Requirement :

For further Information :

Complete this form in writing or typing.

Please submit the form with
a Curriculum Vitae, 2 Recommendation letters,
Photocopy of passport, and Certification of medical degrees

Ms. Nayoung Choe

Phone : +82 2 513 8198
Fax : +82 2 513 8154
E-mail : patrashu@wooridul.co.kr

4. Educational Background
College or University Undergraduate Education
Institution :
Year of Graduation :
Medical School
Institution :
Year of Graduation :

Internship & Residency

Institution :
Year of Graduation :
Other Training :

Have you ever participated in any research projects? If yes, please specify.

Have you published any scientific articles? If yes, please specify.

Have your received any prizes or honors? If yes, please specify.

5. Research Interests

6. Recommendation Letter
1) Name :
Address :

2) Name :
Address :

Personal Essay
(500 words or less)
1.
Why did you choose Orthopedic/Neurosurgery ?
2.
Why did you choose a surgery in spine field ?
3.
Why did you apply for this fellowship ?
4.
How do you plan to apply this training and learning to your practice?
* You may use separate paper.