IN Fellowship Form

INTERVENTIONAL NEPHROLOGY FELLOWSHIP

APPLICATION FORM AND EVALUATION DOCUMENT FOR THE SELECTION OF FELLOWSHIP

📢 Important Announcement: IN Fellowship Application Update

📅 Application Deadlines:

For a January 1 start: Apply by June 30, 2026
For an April 1 start: Apply by August 31, 2026
For a July 1 start: Apply by October 31, 2026
For a September 1 start: Apply by December 31, 2026

🔹 We encourage early applications, as slots are limited for each intake.

Family Name:

First Name:

Country:

Malaysia Others

If Others, please fill in:

Address:

Hospital where you currently work ( Private practice / Academic Institution / Government Hospital ):

Medical Degree:

Scientific societies of which you are a member:

Email:

Mobile Phone:

Possibility of professionally developing the acquired skills

Potential of establish IN practice in your country

Do you plan to develop an IN activity as part of your private practice?

Do you have any sponsors for the program?

Medical specialty (Nephrology/Other):

Previous experience in Interventional Nephrology training ( Specify: year, city, country, period ):

Interventional Nephrology courses ( Specify: year, city, country, period):

Communications / Lectures / Presentations in national / international congresses and conferences (Attach supporting documents in *.pdf format):

Publication on IN in national/international journals (Attach supporting documents in *.pdf format):

Research grants related with IN:

Time worked in Clinical Nephrology (years):

Time worked in an Interventional Nephrology Unit (years):

Total number of Dialysis Catheter insertions in your life:

Total number of Fistulograms / Angioplasties in your life:

Thoracic Endoscopy

Diagnostic Fistulograms / Graftograms

Vascular Ultrasound Mapping

Angioplasty (Balloon Dilation)

Stent Placement (Bare metal & Covered)

Thrombectomy (Mechanical & Thrombolysis)

Pleural procedures

Temporary Dialysis Catheters

Tunneled Dialysis Catheters

Catheter Exchanges / Removals

AV Fistula / Graft Creation

Renal (Kidney) Biopsy

Do you have the resources to be able to pay for the stay and expenses related to the program?

Yes No

Do you have problems in your country to obtain a visa to reside in Malaysia?

Yes No

Does your personal and family situation allow you to complete the 3-month training program?

Yes No

Upload CV ( *.pdf only )

Suggested Date for Fellowship Period: