<p>Eligibility</p><p>Who Can Apply </p><p>Postgraduate students </p><p>Clinical fellows of ophthalmology </p><p>Final year optometry student </p><p>Optometry fellows </p><p>Instructions for filling and submitting the form </p><p>1. The details should be typed and not hand written. 2. The form must be accompanied with relevant supporting documents, must Contain a) Copy of your student ID; and b) recommendation letter from the head of department on institution’s letter head</p><p>3. The forms can be submitted before the stipulated deadline via e mail to: [email protected] with a subject line “ Application for Travel Fellowship” or posted to the VISION 2020 – INDIA office:</p><p>Mrinal Ray Madhaw</p><p>Programme Manager </p><p>VISION 2020: The Right to Sight – INDIA </p><p>D-21, Corporate Park, 2nd floor, </p><p>Sector-21, near Sector 8 Metro Station</p><p>Dwarka, New Delhi – 110 078</p><p>Tel: 011 - 6565 0577 VISION 2020: The Right to Sight- INDIA</p><p>Application for travel fellowship</p><p>1. Name of the Candidate: ...... </p><p>2. Name of the Institution:...... </p><p>3. Qualification obtained:...... </p><p>4. Currently pursuing degree/diploma ...... </p><p>5. Mobile number:...... </p><p>6. E mail id:...... </p><p>7. Give a brief overview of your Institution ( Max 100 words)</p><p>8. Please describe your area of interest (Max 100 words) 9. Please describe the benefits likely to be derived from attending the conference ( Max 100 words) </p><p>10. Workshop/ Seminars already attended </p><p>11. How did you come to know about this fellowship: </p><p>Signature : </p><p>Name : </p><p>Date : Detail of attached supportive documents:</p><p> Copy of Student ID  Letter of recommendation from head of the department (Course you are pursuing at present, should be clearly mentioned)</p><p>Note: </p><p> The selected candidate will receive reimbursement (subject to a maximum of Rs.4500/-) by cheque in favour of the candidate only after he/she attended the conference. 12. Name of the Candidate: ...... </p><p>13. Name of the Institution:...... </p><p>14. Qualification obtained:...... </p><p>15. Currently pursuing degree:...... </p><p>16. Mobile number:...... </p><p>17. E mail id:...... </p><p>18. Give a brief overview of your Institution ( Max 100 words)</p><p>19. Please describe your area of interest (Max 100 words) </p><p>20. Please describe the benefits likely to be derived from attending the conference ( Max 100 words) 21. Workshop/ Seminars already attended along with from and to date</p><p>22. How did you come to know about this fellowship: </p><p>Signature : </p><p>Name : </p><p>Date : </p><p>Detail of attached supportive documents:</p><p> Copy of Student ID  Letter of recommendation from head of the department (Course you are pursuing at present, should be clearly mentioned)</p><p>Note: </p><p> The selected candidate will receive reimbursement (subject to a maximum of Rs.4500/-) by cheque in favour of the candidate only after he/she attended the conference.</p>