Korean Society of Interventional Radiology

KSIR Fellowship

Fellowship 2027the KSIR International Fellowship

Fellowship 2027

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KSIR Fellowship
Fellowship 2027

Application Form for KSIR International Fellowship

Applicant

Full name
Date of birth (d/m/y)	- -
Age
Place of birth
Nationality
Membership of academic societies

Address for correspondence

Address
Phone	+ - - -
Fax	- -
E-mail

Academic career (after high school)

Year : Position

Occupational career

Year : Position

Current position

Current Specialty

Field of interest or what you wish to learn
(multiple selection permitted up to 3 topics)

Requested institution for clinical training (please choose)

No special request

Special request for fellowship at (name of institution)*

Already applied to (only if applicant has already applied)

* Note: although the applicant's selection will be taken into consideration, the choice of institution cannot be guaranteed.

Requested period of clinical training

Inception (d/m/y)	- -
Completion (d/m/y)	- -

Plans after completion of clinical training

Special remarks

Photograph (upper half of body)

select

KSIR Fellowship

Fellowship 2027

Application Form for KSIR International Fellowship

Applicant

Address for correspondence

Academic career (after high school)

Occupational career

Current position

Current Specialty

Field of interest or what you wish to learn
(multiple selection permitted up to 3 topics)

Liver Cancer
(TACE for HCC, DC beads, Radioembolization)

Aortic intervention (EVAR, TEVAR)

PAOD (Peripheral Arterial Occlusive Disease) ? Iliac, SFA,BTK

Portal Hypertension (TIPS, BRTO)

GI tract Intervention (GI stent)

Gynecologic Intervention (Uterine Fibroid Embolization)

Hemodialysis Access (PTA or Stent)

Arteriovenous Malformation (Embolization, Sclerotherapy)

Biliary Intervention (PTBD, Stent)

Venous Intervention (Deep Vein Thrombosis, IVC filter)

Varicose vein Intervention

Others (please specify):

Requested institution for clinical training (please choose)

No special request

Special request for fellowship at (name of institution)*

Already applied to (only if applicant has already applied)

Requested period of clinical training

Plans after completion of clinical training

Special remarks

Photograph (upper half of body)

List of recent (within five years) publications (follow the style of Index Medicus):

Pledge

Medical Report

Cover letter

Recommendation letters

KSIR Fellowship

Fellowship 2027

Application Form for KSIR International Fellowship

Applicant

Address for correspondence

Academic career (after high school)

Occupational career

Current position

Current Specialty

Field of interest or what you wish to learn(multiple selection permitted up to 3 topics)

Liver Cancer(TACE for HCC, DC beads, Radioembolization)

Aortic intervention (EVAR, TEVAR)

PAOD (Peripheral Arterial Occlusive Disease) ? Iliac, SFA,BTK

Portal Hypertension (TIPS, BRTO)

GI tract Intervention (GI stent)

Gynecologic Intervention (Uterine Fibroid Embolization)

Hemodialysis Access (PTA or Stent)

Arteriovenous Malformation (Embolization, Sclerotherapy)

Biliary Intervention (PTBD, Stent)

Venous Intervention (Deep Vein Thrombosis, IVC filter)

Varicose vein Intervention

Others (please specify):

Requested institution for clinical training (please choose)

No special request

Special request for fellowship at (name of institution)*

Already applied to (only if applicant has already applied)

Requested period of clinical training

Plans after completion of clinical training

Special remarks

Photograph (upper half of body)

List of recent (within five years) publications (follow the style of Index Medicus):

Pledge select

Medical Report select

Cover letter select

Recommendation letters select

Field of interest or what you wish to learn
(multiple selection permitted up to 3 topics)

Liver Cancer
(TACE for HCC, DC beads, Radioembolization)

Pledge

Medical Report

Cover letter

Recommendation letters