INTERNATIONAL SOCIETY OF NEPHROLOGY
QUESTIONNAIRE FOR RENAL SISTER CENTER PROGRAM
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| Name of Center: | ||
| Academic Affiliation: | ||
| Full Address: | ||
| City & Postal Code: | ||
| Country: | ||
| Director: | ||
| Tel. #: | ||
| Fax. #: | ||
| E-Mail Address: | ||
| 1. Number of Full-time Faculty: | ||
| 2. Number of dialysis beds: | ||
| 3. Number of transplants per year: | ||
| 4.Fellow Training Program: | yes [ ] | no [ ] |
| If yes: a. Total number of Trainees: 1. Number of clinical fellows: |
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| b. Duration of clinical training:….. (months) | ||
| c. Duration of research training:….. (months) | ||
| d.
1. What percentage of fellows pursue academic medicine?…..% |
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| e. Sources of Fellow salary support: 1) 2) 3) |
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| f. Areas of Faculty Research Interest 1. Basic Research yes [ ] no [ ] Type 2. Clinical Research yes [ ] no [ ] |
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| 5.Relationships with Renal Centers in Developing Countries, e.g. previous fellows, visiting professor, CME course, etc. |
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| 6.Potential interest in becoming an ISN Renal Sister Center with a renal center in the [ ] developing [ ] developed world (suggestions for your Renal Sister Centers please rank): |
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Please send this form and your remarks to the ISN Global Headquarters:
7 Avenue de Gaulois
B-1040 Brussels
Fax: +32.2.2731550
Tel: +32.2.7431546
e-mail: [email protected]
Last Modified: December 22, 2001 06:18:17 AM