Application form

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* 1. First name

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* 2. Family name

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* 3. Email address

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* 4. Date of birth

Date

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* 5. Profession

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* 6. Number of years of postgraduate working experience

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* 7. Institute

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* 8. City

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* 9. Country

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* 10. Please describe the most exciting development you foresee in the coming five years for your profession (maximum 100 words)

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* 11. What are the goals you would want to achieve within the coming 5 years? (maximum 100 words)

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* 12. Please provide concrete examples demonstrating you are ambitious (maximum 100 words)

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* 13. Please provide concrete examples demonstrating you are a team player (maximum 100 words)

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* 14. Please provide concrete examples that show you have the ability to become a leader (maximum 100 words)

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* 15. Please provide a motivation why you would like to participate in a mentoring program. And why specifically in the ESTRO mentoring program (maximum 100 words).

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* 16. Please describe the experience you have had so far with ESTRO (maximum 100 words).

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* 17. How do you see yourself in relation to ESTRO in the future?

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* 18. How do you imagine your ideal mentor spends his/her free time?

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* 19. Please send in together with this form a CV (maximum two pages).

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