WICCEM 2025 – Developing Countries

1. Personal Information

Full Name(Required)

Date of Birth(Required)

Nationality(Required)

Country of Residence(Required)

Email Address(Required)

Phone Number(Required)

2. Educational & Professional Background

Current Training Level(Required)

(e.g., Resident, Fellow, General Practitioner, etc.)

Specialty / Field of Practice(Required)

Institution Name and Location(Required)

Supervisor/Mentor Name and Contact (Email & Phone)(Required)

3. Documents Required

• Upload: Letter of Support from Mentor, Supervisor, or Program Director(Required)

Max. file size: 256 MB.

Requirements:
-Must confirm that the applicant is currently in training in a public program
-Confirm the applicant’s role and how this fellowship will help their clinical duties and community impact.

7. Declaration and Consent

I certify that the information provided is true and complete to the best of my knowledge.(Required)

Yes

I consent to the use of my data for the purpose of evaluating this application(Required)

Yes