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ESCP 6-Month Fellowship Application

Your Details:

Referee Details:

1. Age

2. ESCP membership

3. Committees or young ESCP membership?

4. Time from Graduation from medical school

5. Country of medical school

6. Country of surgical practice

7. EBSQ

8. Attendance to ESCP annual conference?

9. Time in colorectal surgery practice

10. Number of Publications

11. Number of Publications in the field of coloproctology

12. Number of National/International Presentations in past 5 years

13. ESCP snapshot audits

Select all options if applicable.

14. Have you been awarded a fellowship by ESCP in the past

Select all options if applicable.

15. Operative experience past 5 years

16. Research Qualifications

17. International Awards