Fellowship Application Pushpagiri Eye Foundation

Start your Application Long-term fellowships · January & June intakes

Complete the form below and upload the required documents. Fields marked * are required. Each file may be up to 5 MB.

Programme preference

Fellowship programme * Preferred campus * Preferred intake *

Personal details

Full name * Date of birth * Gender * Nationality *

Contact

Email address * Mobile number * Alternate phone Postal address * City * State * PIN code *

Qualifications & experience

MBBS college / university * MBBS year of passing * Postgraduate qualification * PG college / hospital * PG year of passing * Medical registration number * Registration council * Years of experience after PG * Current designation * Current institution / hospital *

Statement of purpose

Why do you want this fellowship? *

Documents

Recent passport photograph * Curriculum vitae (PDF) * MBBS degree / provisional certificate * PG degree / provisional certificate * Medical registration certificate * Photo ID (Aadhaar / passport / PAN) * Additional document (optional)

I declare that the information and documents provided are true and complete. I understand that false information may lead to rejection of this application. *