British Society for Paediatric Dermatology
English Charity No. 1011605
Scottish Charity No. SC038025
APPLICATION FOR PAEDIATRIC DERMATOLOGY TRAINING FELLOWSHIP AWARD
Trainee Members of the British Society for Paediatric Dermatology are invited to apply for a
fellowship grant of up to £2000 for training in Paediatric Dermatology.
NAME … ....................................................................................................................................
JOB TITLE… ……………………………….email……...........................................................
HOME ADDRESS ……………................................................................................................
TEL NO ...........................................................................……….………………………........
WORK ADDRESS ……………………….............................................................................
TEL NO ..................................................................email…….……………………….............
SUMMARY OF INTENDED PAEDIATRIC TRAINING PROGRAMME OR RESEARCH
PROJECT *
FINANCIAL COSTS *
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OTHER FUNDING *
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Signature……………………………………………………Date...........................................
Signature of Head of
Department………………………………………….............Date……………………...........
Please return this form with a short one-page CV (if possible also by email) to: Dr Mary
Glover, Department of Paediatric Dermatology, Great Ormond Street Hospital, London
WC1N 3JH. email: mary.glover@gosh.nhs.uk* a separate sheet can be attached if necessary