Application Form

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Please complete this form to start the process of applying for the Victoria Cohen scholarship for aspiring ocular oncologists. We may contact you for more information.

Note: In order to be considered for an award you need to be able to provide evidence of acceptance to a fellowship program.

Before you start you should have the following documents ready to upload:

Proof of fellowship (Letter from Director of institute)
Your CV / Resume

Both documents should be uploaded in either Microsoft Word or PDF formats.

Personal Details:

Name

Education Details:

Fellowship Details

Upload fellowship proof (letter from institution director) - Max size 2mb

Fellowship Duration

Is this a paid fellowship?

Yes No

Have you received other grants or scholarships for the fellowship?

Yes No

Do you require a visa for the country where you will take your fellowship?

Yes No

If yes, please give details of the process and when you expect your visa to be granted

Once your fellowship is complete
Where will you practice when you are done?

Is there an ocular oncology center or ocular oncologist working in this country?

Yes No

Do you have a confirmed post here already?

Yes No

Upload your CV / Resume (Word or PDF - Max size 2mb)

Tell us about the clinical aspects of your planned fellowship? What skills do you hope to gain?

Will research be a part of your planned fellowship? If so please tell us about the project aims and your future research plans

How will the VCECCT award benefit you?

I have read and accept the Privacy Policy

I have reviewed my responses and I would like to apply for this award.

Looking for more information about the Victoria Cohen Eye Cancer Charitable Trust?

Saving lives, eyes and vision through education

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Victoria Cohen Eye Cancer Charitable Trust is registered with the Charity Commission for England and Wales, with registration number 1194105

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