INTERNATIONAL CLINICAL RESEARCH FELLOWSHIP PROGRAM. SPAIN-USA
Application Form
1. Introduction
The ASBMT-GETH International Fellowship provides specialized clinical and research
training in Stem Cell Transplantation and is intended to build capacity in the home country of
the trainees. Applications will be judged on the merits of the applicant as well as the training
goals and likelihood of the training resulting in improved patient care at the home institution
of the applicant.
Please complete this application form and attach your CV, a letter of interest, a letter in
support of this application from two referees and the research project proposal.
2. Applicant Information
Name:
Mailing Address:
Phone:
E-mail:
Degree(s):
Fax:
3. Qualifications and experience
1. Please list all relevant qualifications (LMS, MD, PhD, CCST, etc)
2. Please describe your previous training in Internal Medicine, Hematology and SCT.
3. Please summarize your research experience (basic, translational, clinical).
4. Training Goals
A. Objectives:
1. Please describe the general objective of your SCT training.
2. Please describe the specific goals of your SCT training.
3. Please describe the new skills you expect to acquire by the completion of your SCT
training.
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B. Please describe how this SCT training will fit in with your overall career plans.
5. Research objectives.
1. Please describe your research interests in general.
2. Please describe the specific research objectives for this program.
3. If you have a research proposal for this program, write a short description (optional).
6. SCT center preferences.
1. Please select your preferences for the GETH SCT Center.

Complejo Hospitalario de Navarra - Pamplona

Hospital Universitario La Fe - Valencia

No preference
2. Please select your preferences for the ASBMT SCT Center.

Colorado Blood Cancer Institute (CBCI) – Denver, CO

MD Anderson Cancer Center (MDACC) – Houston, TX

Memorial Sloan Kettering Cancer Center (MSKCC) – New York, NY

Texas Transplant Institute – San Antonio, TX

University of Minnesota Medical Center – Minneapolis, MN

No preference
Signature
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I certify that the facts and information included in this application and on my CV are honest and
true.
Applicant Signature:
Date:
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