APPLY – PGF PARTICIPANT

Applications are closed

Email Address *

Full Name *

Phone Number

Name of organization/clinic you currently work in (Government or non-government) *

Clinic location in camps or host communities *

Have you completed your MBBS / MBChB and are fully registered with the Bangladesh Medical and Dental Council (BMDC) *YesNo

Please provide your medical registration number. If you do not have a number please explain why not *

How many years since you’ve graduated from medical school? *

Do you have good command over conversational English? *YesNo

Do you meet the essential requirements for the PGF (See the top of the page to download) YesNoOther

Other

Date available to attend PGF *Cohort C: June 13, 2019 – September 9, 2019Cohort D: September 19, 2019 – December 9, 2019

Can you attend either Cohort C or D if accepted? *YesNo

If you answered no to above, please explain

Does your supervisor/organization consent to you attending the PGF? *YesNo

Please describe in detail why you are interested to attend the PGF and how this will benefit your career *0 / 500

If accepted onto the PGF, do you agree to attend a minimum of 75% of the lectures and participate in at least 2 clinical shadowing opportunities? *YesNo

If accepted onto the PGF, do you understand and accept that if you do not attend more than 75% of the PGF you will not pass the PGF? (See Participant Form for list of holidays and days off) *YesNo

Please provide any additional comments

Upload CV *

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.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-is_active .forminator-select-container .forminator-select-list .forminator-dropdown-handle [class*=forminator-icon-] {
color: #17A8E3;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-has_error .forminator-select-container .forminator-select-list .forminator-value,
.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-has_error .forminator-select-container .forminator-select-list .forminator-value {
border-color: #E04562;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-select-container .forminator-select-list .forminator-dropdown-list,
.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-select-container .forminator-select-list .forminator-dropdown-list {
font-size: 16px;
font-family: inherit;
font-weight: 400;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-select-container .forminator-select-list .forminator-dropdown-list,
.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-select-container .forminator-select-list .forminator-dropdown-list {
border-color: #17A8E3;
background-color: #E6E6E6;
color: #777771;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-select-container .forminator-select-list .forminator-dropdown-list li:hover,
.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-select-container .forminator-select-list .forminator-dropdown-list li:hover {
background-color: #DDDDDD;
color: #000000;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-select-container .forminator-select-list .forminator-dropdown-list li.current,
.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-select-container .forminator-select-list .forminator-dropdown-list li.current {
background-color: #17A8E3;
color: #FFFFFF;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-select2 + .select2-container–default .select2-selection–single .select2-selection__rendered,
.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-select2 + .select2-container–default .select2-selection–single .select2-selection__rendered {
font-size: 16px;
font-family: inherit;
font-weight: 400;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-select2 + .select2-container–default .select2-selection–single,
.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-select2 + .select2-container–default .select2-selection–single {
border-color: #777771;
background-color: #EDEDED;
color: #000000;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-select2 + .select2-container–default .selection .select2-selection–single .select2-selection__arrow,
.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-select2 + .select2-container–default .selection .select2-selection–single .select2-selection__arrow {
color: #777771;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-select2 + .select2-container–default .select2-selection–single:hover,
.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-select2 + .select2-container–default .select2-selection–single:hover {
border-color: #17A8E3;
background-color: #E6E6E6;
color: #000000;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-select2 + .select2-container–default .select2-selection–single:hover .select2-selection__arrow,
.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-select2 + .select2-container–default .select2-selection–single:hover .select2-selection__arrow {
color: #17A8E3;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-select2 + .select2-container–default.select2-container–open .select2-selection–single,
.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-select2 + .select2-container–default.select2-container–open .select2-selection–single {
border-color: #17A8E3;
background-color: #E6E6E6;
color: #000000;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-select2 + .select2-container–default.select2-container–open .select2-selection–single .select2-selection__arrow,
.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-select2 + .select2-container–default.select2-container–open .select2-selection–single .select2-selection__arrow {
color: #17A8E3;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-has_error .forminator-select2 + .select2-container–default .select2-selection–single,
.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-has_error .forminator-select2 + .select2-container–default .select2-selection–single {
border-color: #E04562;
}

.forminator-custom-form-9619.forminator-dropdown–default .select2-search .select2-search__field {
font-size: 16px;
font-family: inherit;
font-weight: 400;
}

.forminator-custom-form-9619.forminator-dropdown–default .select2-results .select2-results__options .select2-results__option {
font-size: 16px;
font-family: inherit;
font-weight: 400;
}

.forminator-custom-form-9619.forminator-dropdown–default {
border-color: #17A8E3;
background-color: #E6E6E6;
}

.forminator-custom-form-9619.forminator-dropdown–default .select2-results .select2-results__options .select2-results__option {
color: #777771;
}

.forminator-custom-form-9619.forminator-dropdown–default .select2-results .select2-results__options .select2-results__option:hover,
.forminator-custom-form-9619.forminator-dropdown–default .select2-results .select2-results__options .select2-results__option.select2-results__option–highlighted {
background-color: #DDDDDD;
color: #000000;
}

.forminator-custom-form-9619.forminator-dropdown–default .select2-results .select2-results__options .select2-results__option[aria-selected=”true”] {
background-color: #17A8E3;
color: #FFFFFF;
}

.forminator-custom-form-9619.forminator-dropdown–default .select2-search input,
.forminator-custom-form-9619.forminator-dropdown–default .select2-search input:focus,
.forminator-custom-form-9619.forminator-dropdown–default .select2-search input:hover {
border-color: #17A8E3;
background-color: #FFFFFF;
color: #000000;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-multiselect .forminator-option,
.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-multiselect .forminator-option {
font-size: 16px;
font-family: inherit;
font-weight: 400;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-multiselect,
.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-multiselect {
border-color: #777771;
background-color: #E6E6E6;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-has_error .forminator-multiselect,
.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-has_error .forminator-multiselect {
border-color: #E04562;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-multiselect .forminator-option:hover,
.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-multiselect .forminator-option:hover {
background-color: #DDDDDD;
color: #000000;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-multiselect .forminator-option.forminator-is_checked,
.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-multiselect .forminator-option.forminator-is_checked {
background-color: #17A8E3;
color: #ce1414;
}

.forminator-custom-form-9619.forminator-calendar–default {
font-family: inherit;
}

.forminator-custom-form-9619.forminator-calendar–default:before {
border-color: #17A8E3;
background-color: #E6E6E6;
}

.forminator-custom-form-9619.forminator-calendar–default .ui-datepicker-header .ui-corner-all {
background-color: #17A8E3;
color: #FFFFFF;
}

.forminator-custom-form-9619.forminator-calendar–default .ui-datepicker-header .ui-datepicker-title select {
border-color: #BBBBBB;
background-color: #FFFFFF;
color: #777771;
}

.forminator-custom-form-9619.forminator-calendar–default .ui-datepicker-calendar thead th {
color: #333333;
}

.forminator-custom-form-9619.forminator-calendar–default .ui-datepicker-calendar tbody td a.ui-state-default,
.forminator-custom-form-9619.forminator-calendar–default .ui-datepicker-calendar tbody td.ui-state-disabled span {
border-color: #E6E6E6;
background-color: #E6E6E6;
color: #777771;
}

.forminator-custom-form-9619.forminator-calendar–default .ui-datepicker-calendar tbody td a.ui-state-default:hover,
.forminator-custom-form-9619.forminator-calendar–default .ui-datepicker-calendar tbody td a.ui-state-default.ui-state-hover {
border-color: #DDDDDD;
background-color: #DDDDDD;
color: #777771;
}

.forminator-custom-form-9619.forminator-calendar–default .ui-datepicker-calendar tbody td a.ui-state-default:active,
.forminator-custom-form-9619.forminator-calendar–default .ui-datepicker-calendar tbody td a.ui-state-default.ui-state-active {
border-color: #17A8E3;
background-color: #17A8E3;
color: #FFFFFF;
}

.forminator-custom-form-9619.forminator-calendar–default .ui-datepicker-calendar tbody td a.ui-state-default.ui-state-highlight {
border-color: #17A8E3;
background-color: #C8DEE7;
color: #17A8E3;
}

.forminator-custom-form-9619.forminator-calendar–default .ui-datepicker-calendar tbody td a.ui-state-default.ui-state-highlight:active,
.forminator-custom-form-9619.forminator-calendar–default .ui-datepicker-calendar tbody td a.ui-state-default.ui-state-highlight.ui-state-active {
border-color: #17A8E3;
background-color: #17A8E3;
color: #FFFFFF;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-button-upload,
.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-button-upload {
font-size: 14px;
font-family: inherit;
font-weight: 500;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-file-upload > span,
.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-file-upload > span {
font-size: 12px;
font-family: inherit;
font-weight: 500;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-button-upload:hover,
.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-button-upload:hover {
background-color: #d30202;
color: #FFFFFF;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-button-upload:active,
.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-button-upload:active {
background-color: #ff0202;
color: #FFFFFF;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-button-delete,
.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-button-delete {
background-color: rgba(0,0,0,0);
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-button-delete:hover,
.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-button-delete:hover {
background-color: #F9E4E8;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-button-delete:active,
.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-button-delete:active {
background-color: #F9E4E8;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-button-delete [class*=”forminator-icon-“],
.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-button-delete [class*=”forminator-icon-“] {
color: #E04562;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-button-delete:hover [class*=”forminator-icon-“],
.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-button-delete:hover [class*=”forminator-icon-“] {
color: #E04562;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-button-delete:active [class*=”forminator-icon-“],
.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-button-delete:active [class*=”forminator-icon-“] {
color: #E04562;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-button-submit,
.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-button-submit {
font-size: 14px;
font-family: inherit;
font-weight: 500;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-button-submit:hover,
.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-button-submit:hover {
background-color: #a80000;
color: #FFFFFF;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-button-submit:active,
.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-button-submit:active {
background-color: #ed0700;
color: #FFFFFF;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-pagination-steps .forminator-step .forminator-step-label,
.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-pagination-steps .forminator-step .forminator-step-label {
font-size: 12px;
font-family: inherit;
font-weight: 500;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-pagination-steps .forminator-break,
.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-pagination-steps .forminator-break {
background-color: #777771;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-pagination-steps .forminator-break:before,
.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-pagination-steps .forminator-break:before {
background-color: #17A8E3;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-pagination-steps .forminator-step .forminator-step-dot,
.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-pagination-steps .forminator-step .forminator-step-dot {
border-color: #777771;
background-color: #17A8E3;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-pagination-steps .forminator-step.forminator-current ~ .forminator-step .forminator-step-label,
.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-pagination-steps .forminator-step.forminator-current ~ .forminator-step .forminator-step-label {
color: #777771;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-pagination-steps .forminator-step.forminator-current ~ .forminator-step .forminator-step-dot,
.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-pagination-steps .forminator-step.forminator-current ~ .forminator-step .forminator-step-dot {
border-color: #777771;
background-color: #777771;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-pagination-progress .forminator-progress-label,
.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-pagination-progress .forminator-progress-label {
font-size: 12px;
font-family: inherit;
font-weight: 500;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-pagination-progress .forminator-progress-bar,
.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-pagination-progress .forminator-progress-bar {
background-color: #E6E6E6;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-pagination-progress .forminator-progress-bar span,
.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-pagination-progress .forminator-progress-bar span {
background-color: #17A8E3;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-button-back,
.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-button-back {
font-size: 14px;
font-family: inherit;
font-weight: 500;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-button-back:hover,
.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-button-back:hover {
background-color: #159C85;
color: #FFFFFF;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-button-back:active,
.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-button-back:active {
background-color: #159C85;
color: #FFFFFF;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-button-next,
.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-button-next {
font-size: 14px;
font-family: inherit;
font-weight: 500;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-button-next:hover,
.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-button-next:hover {
background-color: #159C85;
color: #FFFFFF;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-button-next:active,
.et-db #et-boc .et_pb_module .forminator-ui.forminator-custom-form-9619.forminator-design–default .forminator-button-next:active {
background-color: #159C85;
color: #FFFFFF;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .StripeElement {
padding: 9px;
border-width: 1px;
border-style: solid;
border-color: #777771;
border-radius: 2px;
background-color: #EDEDED;
color: #000000;
transition: 0.2s ease;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .StripeElement:hover {
border-color: #c61313;
background-color: #E6E6E6;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .StripeElement–focus,
.forminator-ui.forminator-custom-form-9619.forminator-design–default .StripeElement–focus:hover {
border-color: #ff1919;
background-color: #E6E6E6;
}

.forminator-ui.forminator-custom-form-9619.forminator-design–default .StripeElement–invalid,
.forminator-ui.forminator-custom-form-9619.forminator-design–default .StripeElement–invalid:hover,
.forminator-ui.forminator-custom-form-9619.forminator-design–default .StripeElement–focus.StripeElement–invalid {
border-color: #E04562;
}

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