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Applicant must be an ESAIC Active Member.
Applicant must be A young specialist in Anaesthesiology, Intensive Care, or Pain Management.
The Course is held over 2 weeks, the first week in late October/beginning November and the second week in the following April. You must attend both weeks to complete the course. Please, only apply if you are able to attend both weeks. Applicants must send the application form no later than 15 May 2022 before the course.
All questions must be answered and requested attachments sent together with the application form. Incomplete applications will not be reviewed by the selection committee and will be rejected.
Applicants will be advised of the outcome of their application no later than 1st September.

"*" indicates required fields

1. Personal Details

Name*
Address*
MM slash DD slash YYYY
*Following the Common European Framework of Reference, indicate your level of fluency next to each language from A1 - C1. Example: English – C1 - advanced.
Please attach relevant certificate(s) of best foreign language (if applicable.)

2. Education

*Please fill in the date and the centre where you took your EDAIC Part I Exam.
*Please fill in the date and the centre where you took your EDAIC Part II Exam.

3. Teaching experience and commitment

Do you have a University teaching position?*

4. Teaching courses attended

ALS Instructors course*
ATLS Instructors course*
Regular involvement in Simulation teaching*
Have you ever received training as a teacher?*

5. Motivation

6. Personal Profile

Write a max 300-word profile of yourself. Please refer to the following points.
- If yes, specify date and centre.
- Your involvement in evaluation and assessment of residents.
- Any involvement in Curriculum development.

- Describe how the Teach the Teacher Course will help in your personal development.
- Include a brief description of your career aims over the next 5 years.

7. Recommendation from National Society

If you have a letter of recommendation from your National Society, you must include it along with your application. Please upload it along with the other attachments.

8. Sharing your information

Our subcontractor (the hotel) would like to contact you to offer you a shuttle service from the airport to the hotel and restaurant information (menu and prices).

Do you agree to share your email address with the hotel for the following purposes:
I allow ESAIC Secretariat to share my email address with the hotel for hotel shuttle service.*
I allow ESAIC Secretariat to share my email address with the hotel for restaurant information.*
- Letter of recommendation from your National Society
- any additional documents
- Uploads are limited to 20 MB

Important: Please merge all documents into one pdf
Remove passwords and security protection from the PDF files.
Drop files here or
Max. file size: 20 MB, Max. files: 5.