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* 1. Privacy Policy Consent
Information collected from you will be added to our database. We may use this for administrative purposes in conducting our work, and for communication with you. In compliance with the GDPR all information will be treated confidentially and will not be shared with any other organisation without your explicit and informed consent. For further information on how we hold and use your personal data please read our Privacy Policy at http://www.eacts.org/home/privacy-policy/

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* 2. Last Name

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* 3. First Name

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* 4. Email Address

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* 5. Course Applying For Scholarship To Attend

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* 6. Date of Birth

Date

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* 7. Country of Birth

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* 8. Main Specialty

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* 9. Current City of Residence

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* 10. Current Chief of Department

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* 12. EACTS Membership Id Number

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* 14. CV

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* 15. Letter of support by the Chief of your unit/department

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* 16. I have received an EACTS Scholarship/Grant before

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* 17. I received the following scholarship/grant ...

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