CUA-SIU International Scholarship Program | CUASF – Canadian Urological Association Scholarship Foundation

Name (in full) *

Date of birth *

CUA Membership Number *

Citizenship *

Mailing Address *

Email address *

Telephone # work *

Telephone # home *

Fax *

Location of Urology Fellowship *

Brief Description of Fellowship *

Date *

Place *

Name of Applicant *

Personal letter of support, including how their application meets the Program’s “Objective”

Trainees need to provide a declaration of intent to return to their home country following completion of training AND confirmation of acceptance at the institution, which includes stated length or dates of training period

Letter of recommendation from a home country medical institute

Curriculum Vitae (Please submit a pdf version of your Common (CIHR) CV)