Professor Heimburger Award Application

Name of Applicant

Medical Degree / PhD Obtained (title, year and place)

Hospital / Institution (name and address)

Title of Research Project

Is this research project pre-clinical or clinical? Pre-Clinical Clinical

Email for contact

Other involved scientists (for each provide name, academic title and brief description of involvement in the research project)

Please upload the following documents below:

Short CV (max. 1-5 pages)
Research proposal (one page, including name and institute)

If you have any queries or issues with uploading your short CV and/or one-page research proposal, please contact the Heimburger Award Facilitator at Heimburger.Award@cslbehring.com.

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Please confirm:

Herewith I confirm that I have read and accept the eligibility as well as the details regarding the application procedure

Thank You

Your application is being processed.