Name (required)

Email (required)

Date of birth - DD/MM/YYYY (required)

Age by December 31, 2020 (required)

WORK ADDRESS

Institution (required)

Street (required)

Zip Code (required)

City (required)

Country (required)

Phone

Work e-mail address

Position held in this Institution (required)

From date - MM/YYYY (required)

CURRICULUM VITAE

1. Undergraduate Degree
University - Indicate city and country (required)
Degree (required)
Year of graduation (required)

2. Graduate Training

Pediatrics
Institution
Duration
Start and completion dates

Pediatric Endocrinology
Institution
Duration
Start and completion dates

Other training (if applicable)
Institution
Duration
Start and completion dates

Other training (if applicable)
Institution
Duration
Start and completion dates

Academic Post-Graduate (indicate all that apply)

Master Thesis
University (indicate city and country)
Start date
Completion date (or in progress)
Title

PhD Thesis
University (indicate city and country)
Start date
Completion date (or in progress)
Title

Other
Type
University (indicate city and country)
Start date
Completion date (or in progress)
Title

3. LIST OF PUBLISHED FULL ARTICLES
(Authors in the order listed in the publication, Journal, Year, volume, pages, DOI) (PS: do not list congress abstracts here)

3.1
3.2
3.3
3.4
3.5
3.6
3.7
3.8
3.9

4. LIST OF ABSTRACTS PRESENTED AT SCIENTIFIC MEETINGS

AS PRESENTING AUTHOR
(Authors in the order listed in the publication, Journal, Year, volume, pages, DOI)
4.1
4.2
4.3
4.4
4.5
4.6
4.7
4.8
4.9

AS CO-­‐AUTHOR
(Authors in the order listed in the publication, Journal, Year, volume, pages, DOI)
5.1
5.2
5.3
5.4
5.5
5.6
5.7
5.8
5.9

Are you proficient in written and spoken English (Yes or No)

Previous Participations in SLEP, JOINT or GLOBAL Meetings (NO or YES – if yes, indicate places and years):
6.a
6.b
6.c
6.d

To complete your application you must attach a letter of recommendation signed by a SLEP member in PDF format