INTERNATIONAL YOUNG ENDOSCOPIST AWARDS (IYEA) 2020

APPLICATION FORM
To be filled out by applicant (Please type)

PERSONAL INFORMATION
(Given)
Name in Full (Middle)
(Family)
Nationality Gender ☐ Male ☐ Female
Date of Birth (Ex.
Place of Birth
1988/FEB/13)
Mobile number Fax
Email (Primary) Email (Secondary)
Institution (Hospital)
* Number of endoscopic * Number of endoscopic
instruments procedures per year
Department
Present Professional Position
Applying Subspecialty ☐ UGI Endoscopy ☐ LGI Endoscopy ☐ ERCP ☐ EUS
Office Address
Home Address
Special Dietary Requirements ☐ Vegetarian ☐ No Beef ☐ No Pork ☐ Halal
(If any) ☐ etc. ( )

EDUCATIONAL BACKGROUND
Medical School Attended & Dates
Postgraduate Degree (Final)
Residency
Fellowship
Others

PAPERS PUBLISHED IN ENGLISH DURING THE LAST FIVE YEARS (Please attach separately)
 REASONS FOR APPLYING FOR IYEA 2020
(A personal statement of what is to be learned and how it will improve GI endoscopy practice back in your country)

I certify that the information I have provided on this application is true and accurate to the best of my
knowledge.

Signature of Applicant: Date:

■ SUBMISSION GUIDELINES
1. Applicants should apply to their preferred field of participation: UGI endoscopy, LGI endoscopy, ERCP or EUS.
2. The training center for each applicant will be selected by the IDEN Public Affairs Committee.
3. Required documents:
1 Completed application form including a written personal statement on reasons for seeking training.
2 Curriculum vitae including a recent photo
3 Two letters of recommendation: one from your training preceptor/director and the other from the
president of your society of GI endoscopy
※ If it is difficult to submit a recommendation letter from your GI endoscopy society, please submit a
recommendation letter from another society that you belong.
4 Lists of published articles written in English (During the last 5 years)
5 A photocopy of your passport showing the photograph and identification information
6 [Optional] The results of an English proficiency test: TOEIC, TOEFL, IELTS, G-TELP, etc.
(Any kind of internationally recognized English language test score or certificate may be submitted)
4. Completed applications and all correspondence should be sent to the IDEN-IYEA 2020 Secretariat.
(IYEA@iden.or.kr)
5. It is the responsibility of the applicants to obtain the visa (if required) and travel insurance.

■ DUTIES (Aside from training)

1. Oral and poster presentation (topics related to GI endoscopy) during the Young Endoscopist Forum
2. Abstract submission
3. Accepted abstracts will be presented at both the Young Endoscopist Forum and IDEN 2020
4. IDEN 2020 registration; registration fees will be refunded on site
5. Apply and obtain IDEN membership
6. Sincere educational attitude at the training center
7. Submission of evaluation sheets after training

■ DEADLINES
- Deadline for application submission: February 28, 2020
- Notification of acceptance: after March 25, 2020

■ CONTACT INFO
IDEN 2020 Secretariat
Email: IYEA@iden.or.kr Tel.: +82-2-557-8422, 8423 Fax: +82-2-557-8428 Website: www.iden.or.kr