Application - Climate Fresk Workshop - November 17, 2023 Applicant information Question Title * 1. Last name Question Title * 2. First name Question Title * 3. Email address Question Title * 4. Student number Question Title * 5. Academic program: MD MSc MPH PhD MD/PhD Postgraduate medical education TMM Other (please specify) Question Title * 6. Program details (e.g., MSc in Epidemiology) Question Title * 7. Year of study / graduation year (e.g., Y1 / 2026) Question Title * 8. Are you registered in the Concentration in Global Health and Social Accountability? Yes No Question Title * 9. Please describe your interest in climate change, global health and planetary health and how participating in this workshop will enrich your education and experience (max. 200 words). Question Title * 10. Please explain if you currently involved or would you like to be involved in any sustainability or climate action initiatives in your local community or at the Faculty of Medicine (max. 200 words) Question Title * 11. Please upload a copy of your CV (max. 3 pages). PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only. Choose File Choose File No file chosen Remove File Please upload a copy of your CV (max. 3 pages). Question Title * 12. It is important to note that this workshop can be offered to a restricted number of participants to allow proper discussions and facilitations. The IGHO team is covering the fees for all participants. Thereby, it is important to read through the conditions below and confirm that by submitting this form, you are agreeing to all the following statement (please tick all statements): Priority for attending this workshop is given to students registered in the Concentration in Global Health and Social Accountability Your application does not represent a confirmation of your participation in the workshop Your application will be reviewed based on your answers and you will be informed by the IGHO team if your application was accepted, rejected or added to a waiting list Once your application is approved, you have 24hours to confirm or revoke your attendance If you have a last-minute illness or conflict, you must give at least 24 hours' notice so that your seat can be offered to someone else SUBMIT