Latika Roy Foundation-Adhyan Foundation Fellowship – Latika Roy Memorial Foundation

Latika Roy Foundation-Adhyan Fellowship

Our staff…the richest resource

LATIKA-ADHYAN FELLOWSHIP IN
DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS

APPLICATION FORM
2024—2025

* = Required fields

Name(Required)

Date of Birth(Required)

Phone(Required)

Alternate Phone (optional)

Email(Required)

Address(Required)

Central IAP membership number:(Required)

IAP chapter of neuro-developmental pediatrics membership:(Required)

Qualifications

Course(Required)

Year of Passing(Required)

Institution(Required)

Grade/ Marks(Required)

Work experience(Required)

Area/s of interest(Required)

Name and contact number of last employer/ HOD of last institution attended(Required)

Attachments

Please tell us in 100 words why you want to specialize in Developmental Pediatrics. What is it about this field that you find exciting and challenging?(Required)

Accepted file types: jpg, png, pdf, Max. file size: 1 MB.

(Tell us on a separate sheet of paper in 100 words.)

Tell us what you understand by family-centered care.(Required)

Accepted file types: jpg, png, pdf, Max. file size: 1 MB.

(Tell us on a separate sheet of paper in 100 words.)

LRF is Now Latika

(Shorter is Sweeter!)

LRF is Now Latika

(Shorter is Sweeter!)