ICP Fellowship form

Eligibility criteria for ICP Fellowship can be found Here

For any queries, please email at api.hdo@gmail.com or call at - (022) 6666 3224.

Please mention NA in case of no information available for any point.

field with mark star is required

For uploading documents maximum size allowed is 2MB.

Format of file name for uploading documents

Your name_document name (e.g. Dr_xyz_pg_degree_certificate.png)

1. Name in Full(Surname First)(in Block Letters): *

2.(a) API Membership Number:

2.(b) Date of Joining *

3. Date of Birth: *

Address Residence: *

Address Office: *

Telephone:

Mobile: *

Email: *

Postgraduate degree in Medicine: *

Year of passing:*

Institute:*

University:*

Other Professional Qualification:

Year of passing:

Institute:

University:

Add Row

6. Experience in Medical Profession after Postgratuation in Medicine:

Name of Hospital/Clinic/Organisation & Location:

Number of Beds (if applicable):

Post held:

Period Served year wise (From):

Period Served year wise (To):

Add Row

7. Publications: List below. (If number of publications in Journals exceeds 8, publications which can qualify as research papers may be listed under Research section 9.)

a. Number of Publications in Indexed National / International Journals:

b. Number of Chapter in Books / monograms:

c. Editorship of National level or State level: Book /Monogram/Update Series:

8 Honours And Awards

(a) Oration in National / State Association Meeting

Title of Oration:

Organisation:

Year:

Add Row

8. (b) Award National / International / or State level

Title of Award:

Organisation:

Year:

Add Row

9. Research work (list below)

(a) Research sanctioned & funded by Research Agency

(b) Departmental Research. (To qualify, the findings should be published in National/International Journal) Do not include papers already listed under Publications

10. Contribution to API (list below and attach proof)

Post held in Organisation/Meeting:

Name of Organisation/Meeting/CME:

National/Zonal/Under API/ICP State level:

Year:

Add Row

11. Participation in CME or Scientific Sessions of API or ICP as Faculty:

Speaker/Chairperson/Other:

Title of Talk / Session:

Name of meeting:

Year:

Add Row

12. Social welfare / Community service. (Include under the headings given below, with documentry evidence)

(a) Emergency services during National calamities (Quakes/Floods/Cyclones,etc)

(b) Public education Programme (Radio), TV talk/writing in news papers.

Service:

Add Row

Indian College of Physicians Citation

Please share the details of two proposers for recommendation:

The Fellows proposing and seconding the nomination for Fellowship of Indian College of Physicians should highlight the professional / scientific achievements of the candidate and the contribution to A. P. I. from personal knowledge in 200 words and email them to api.hdo@gmail.com

Proposer:

Name:

Membership No.:

Mobile Num:

Email:

Seconder :

Name:

Membership No.:

Mobile Num:

Email:

Note: The Fellowship form should be proposed and seconded by Founder Fellow / Fellow of ICP only. In case there are more than 3 nominations by any proposer/seconder, the first three nominations in order of receipt in API Office and complete in all respects will be considered for award of Fellowship of ICP and the others rejected for consideration.

ICP Fellowship form

Indian College of Physicians Citation

The Indian College of Physicians

Links

Contact Info

ICP Fellowship form

Indian College of Physicians Citation

The Indian College of Physicians

Links

Social Media

Contact Info