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 *

A letter of intent, stating how the fellowship meets the Program’s “Objective” and a declaration of intent to return to their home country following completion of fellowship training

Confirmation of acceptance to a urology fellowship (clinical and/or research) at a Canadian 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)