specific conditions:

145 Macquarie Street, Sydney NSW 2000 http://www.gesa.org.au

APPLICATIONfor

2009 Duke UniversityClinical Research Fellowship

In Hepatology

Closing Date 31 August 2008

Postal & Courier AddressGESA

145 Macquarie StreetSYDNEY NSW 2000

Applications must be on this original application form

LATE, FAXED OR INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED

GESA—Application for Postdoctoral Research Fellowship

http://www.gesa.org.au/

SPECIFIC CONDITIONS:

DUKE CLINICAL RESEARCH FELLOWSHIP IN HEPATOLOGY

PURPOSE

The Fellowship is designed for Australian and New Zealand graduates seeking further training in research methodology and is to be undertaken at the Duke Clinical Research Institute at Duke University Medical Center, North Carolina.

DEFINITION

Areas covered by the Fellowship will include hypothesis formulation, protocol development, statistical analysis, database organisation and manuscript preparation in the clinical investigation of liver disorders with a particular emphasis on viral hepatitis.

CAREER STAGE

The Fellowship is intended for medical graduates with previous training in hepatology who are at or near the end of their clinical training. Previous experience in clinical research would be of benefit but is not essential.

VALUE

Remuneration will range from US$30,000 - $40,000. Travelling expenses and accommodation are not provided.

SUPERANNUATION

The Society does not contribute to superannuation, loadings or continuation of service. Furthermore, time spent under this fellowship is unlikely to be counted as service contributing towards long-service leave or study leave by the administering organisation.

ADDITIONAL EARNINGS

Clinical patient care is negotiable with the institution should the applicant wish to accept the Fellowship for a two year period.

TENURE

The Fellowship is for one year in the first instance with the possibility of an extension of a further year.

The Fellowship will commence in January or February 2009.

ELIGIBILITY

An applicant is required to: Be a financial member of the Gastroenterological Society of Australia or the Gastroenterological

Society of New Zealand. Financial is defined as “confirmed as a member of the society prior to taking up the award”;

Correctly complete the application form and lodge it with attachments and two (2) referee reports prior to the closing date.

GESA—Application for Duke University Medical Center Research Fellowship in Hepatology 2009

DATE RECEIVED:

Application for

Duke University Medical Center Clinical Research Fellowship in Hepatology

Closing Date 31 August 2008

1 Title Gender (M/F)

Surname

Given Names

Date of Birth Format: DD MM YYYY

2 I am a: (Please tick one category only)

Medical graduate with MD/PhD (circle appropriate degree)

Science graduate with PhD

3 Current Contact Address

State Postcode

Phone Facsimile

Email


6 Citizenship/Medical/Professional Registration

(a) Are you an Australian citizen? Enter yes or no

(ii) If you answered no to the above do you hold permanent Australian residency status?

Evidence of residency status must be attached to application

(b) Proof of Australian medical registration (if applicable)

State of registration, registration number and expiry date:

Please attach evidence of your current Australian registration.

Applications received without this will not be further considered

7 QualificationsPlease include the title of any theses produced.Applicants who have overseas qualifications should have their qualifications accredited by the Department of Education Science and Technology. If this is not able to be done by the time of application, the Head of Department and Head of Institution at the applicant’s institution should certify that the qualification in question is authentic and that accreditation will be undertaken by the Department of Education Science and Technology.

Year’s Qualifications Institution Theses title


8 Career Chronology From Beginning of Tertiary StudiesPositions held (include clinical positions and further technical training), including current positions. Please list in chronological order.

(a) Year Employment or Study Institution

(b) (Medical graduate with further clinical training ONLY)—Indicate postgraduate clinical qualifications.

First-part exam (or equivalent) passed

Specialty training in progress

OR

Specialty training completed


9 Research Experience

a. Additional qualifications e.g. MD or PhD. (Where the applicant has completed a research-oriented/based degree, they should indicate the duration, amount of research compared with coursework and whether it was full-time, part-time and/or concurrent with another degree.)

b. Research experience e.g. electives, full or part-time research, apart from higher degree


10 Honours and Awards


11 PublicationsThe Applicant’s publications should be listed as:i) Refereed journal articles (indicate clearly whether published or in press)ii) Other articles, reviews, book chapters, etc.iii) Published Abstractsiv) Case Reportsv) Patents


12 Signatures

Applicant Signature

Title and Name

Date

Title and Name

Date

Signature

Title and Name

Date


APPLICANT DETAILS

Name:

Institution:

GASTROENTEROLOGICAL SOCIETY OF AUSTRALIA

Supporting Reference: Duke University Medical Center Clinical Research Fellowship in Hepatology

Note: THIS REFERENCE IS TO BE FORWARDED WITH APPLICATIONClosing Date: 31 August 2008

FIRST NAME

LAST NAME

MAILING ADDRESS

POSTCODE

TITLE

QUALIFICATIONS

PRESENT APPOINTMENTS

REFEREES ARE TO PROVIDE A SUPPORTING REFERENCE IN RELATION TO PREVIOUS RESEARCH WORK UNDERTAKEN BY THE APPLICANT IN WHICH YOU MAY HAVE BEEN INVOLVED:


FAILURE TO SUBMIT THIS REFERENCE BY THE DUE DATE OF 30 AUGUST 2008 WILL RULE THE APPLICATION INELIGIBLE.

Signature of referee

Date

PLEASE ENSURE THAT THIS REFERENCE IS SUBMITTED WITH THE FULL APPLICATION.


CHECKLIST

Checklist of application requirements. This sheet must be completed.

Applicant

Department

Institution

Phone Number ( )

Yes No

Certification of Medical/Professional registration in Australia

Academic transcript (to be attached at the end of application)

Two Supporting References


specific conditions:

Documents