2018APPLICATION FOR TEG FELLOWSHIP AT LSHTM

  1. PERSONAL DETAILS

Surname: / ______/ Title: / Dr/Mr/Mrs etc
First names: / ______/ Gender: / Male Female
Nationality: / ______/ Date of birth: / day / month / year
Permanent Address: / Correspondence Address:
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Postcode / ------/ Postcode / ------
Country / ------/ Country / ------
Telephone / ------/ Telephone / ------
Mobile / ------
Email address / ------/ (we will use email as the main method of contacting you)
  1. HIGHER EDUCATION (degrees held or currently being taken)

University/College / Qualification
(BSc/MSc etc) / Subject / Course Dates
From To / Final Result / Language of instruction
______/ ____ / ______/ m/y / m/y / ______/ ______
______/ ____ / ______/ m/y / m/y / ______/ ______
______/ ____ / ______/ m/y / m/y / ______/ ______
______/ ____ / ______/ m/y / m/y / ______/ ______
______/ ____ / ______/ m/y / m/y / ______/ ______
IMPORTANT: A scanned/electronic copy of each transcript must be submitted with your application form
Please give details of your highest mathematics qualification or any mathematical/statistical experience / ______
______
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  1. LANGUAGES

First Language: / ______
Other Languages: / ______
  1. EMPLOYMENT

Dates of Employment / Type of Contract
(fixed, temporary or permanent) / Responsibilities / Name and Address of Employer (including country)
From / To
m/y / m/y / ______/ ______/ ______
m/y / m/y / ______/ ______/ ______
m/y / m/y / ______/ ______/ ______
m/y / m/y / ______/ ______/ ______
m/y / m/y / ______/ ______/ ______

NB: Please also send a full electronic version of your CV with this application

  1. REFERENCES

You must supply TWO references. If you have studied in the last 5 years please include a reference from an academic familiar with your work and a second reference from your employer.
FIRST REFEREE: / SECONDREFEREE:
Name: / ______/ Name: / ______
Position: / ______/ Position: / ______
Address: / ______/ Address: / ______
______/ ______
______/ ______
Telephone: / ______/ Telephone: / ______
Email: / ______/ Email: / ______
NB: Reference forms can be downloaded from the LSHTM website. Please complete section 1 (applicant details) of the form and send an electronic copy toeach referee. You should ask each of your referees to return the reference directly to () by 13th April 2018. Applications received without two references will not be considered.
  1. PERSONAL STATEMENT

Your personal statement should include reasons for why you wish to apply for the TEG Fellowship, why you think that you would be a suitable candidate and how your past academic/employment experiencehas equipped you for the Medical Statistics MSc/TEG Fellowship.
  1. RETURNING THE APPLICATION

Please return this applicationform (along with your CV and academic transcripts) by email to . Please write “TEG Fellowship Application” and your name in the subject line of the email.
The completed application form must reach LSHTM by 13thApril 2018.Applications received after this date will not be considered.
A panel of staff from LSHTM will decide on a short-list of candidates based on the completed application form and references.The short-listed candidates will be interviewed by telephone in May or June. The successful candidate will be informed shortly after the interviews have been completed.
If you are currently applying for other sources of funding for the MSc in Medical Statistics at LSHTM then we advise that you should also complete the MSc application which can be downloaded from the LSHTM website ( on which you should state the source of your funding. Those applying only for the TEG Fellowship should not apply separately for the MSc.
Please check that you have:
/ completed all sections of the application form
/ enclosed your academic transcript(s)
/ enclosed your Curriculum Vitae/Resumé
/ given the TEG fellowship referee form to two referees asked them to send the reference to