Registration Form

Languages

English Mandarin

INSTITUTIONAL AFFILIATION

Current position

Location (City/Country)

Degree

Resident Fellow Attending Staff

Upload your medical licence

PROPOSED START DATE & LENGTH OF FELLOWSHIP

Intended field of interest

Intended length of stay *

Start Date: End Date:

Is partial or full funding available to you in support of a fellowship appointment?

Yes No

Would you like to apply for our special one-year paid program?

Yes No

NOTICE

After you have submitted the ONLINE APPLICATION, please submit the REQUIRED DOCUMENTS BELOW (in English or Chinese) to register@ircadtaiwan.com.tw. Contact our Fellowship Manager to confirm your application has been received. Due to a long waitlist and capacity we can take, it may take a while for us to respond. Please note that by submitting this form does not confirm your spot in our program.

REQUIRED DOCUMENTS (IN ENGLISH / CHINESE)

One 2x2 in Color ID Photo (Formal)
A copy of Passport (at least valid for 6 months)
Curriculum Vitae (CV)
A copy of Diploma (Bachelor, Master, and/or Ph.D. and notarized if necessary)
A copy of Medical Practice License (in English)
A copy of Certificate of Working Experience more than one year (in English)

A copy of Certificate of Current Employment at least within 6 months of date (in English)
2 Recommendation Letters (at least one is required, two is preferred)
A Letter of Intent to Director Dr. Wayne Shih-Wei Huang (include your purpose of study, exact duration of your stay, intended field of interest, & possible clinical project in this program)
A copy of Diploma (Bachelor, Master, and/or Ph.D. and notarized if necessary)
English Health Report (Please read below)
Any other supplement materials (in English or Chinese)

HEALTH REPORT (IN ENGLISH / CHINESE)

Preliminary Health Report is required at time of application
Another Health Report is required to be done within a year from fellowship starting date before you arrive Taiwan
For fellowship duration WITHIN 3 months = English Health Report MUST CONTAIN Chest X-ray, Hepatitis B & C
For fellowship duration OVER 3 months = English Health Report MUST CONTAIN Chest X-ray, Hepatitis B & C, RPR(STS)/VDRLtest, Measles, Rubella (MMR)
If results show POSITIVE for either Hepatitis B & C, RPR(STS)/VDRLtest, Measles, Rubella (MMR), please also kindly show report of vaccination

YES, I HAVE READ ALL NOTICES IN THE ONLINE PRE-REGISTRATION, REQUIRED DOCUMENTS, & HEALTH REPORT INFORMATION. BY COMPLETING THIS APPLICATION, I HEREBY CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND CORRECT.

I DECLARE THAT I HAVE READ AND ACCEPTED THE GENERAL CONDITIONS, USE, AND TERMS OF IRCAD-TAIWAN

Cancellation policy

CGV

Early Bird purchases are non-refundable.

Free Cancellation until 45 days Prior to the course starting date, otherwise we will charge you a cancellation fee in the following:

Day prior

Cancellation fee

45 days (including) and more

100% Refund

44 days (including) – 31 days

75% Refund

30 days (including) – 15 days

50% Refund

14 days (including) – 0 days

No Refund

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ONLINE APPLICATION

PERSONAL DATA

INSTITUTIONAL AFFILIATION

PROPOSED START DATE & LENGTH OF FELLOWSHIP

FUNDING

Early Bird purchases are non-refundable.

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