Allergy-Asthmakolkata

DIPLOMA IN ALLERGY ASTHMA & IMMUNOLOGY (DAAI)

Conducted by

INTERNATIONALASTHMA SERVICES (IAS),Colorado USA INSTITUTE OF ALLERGY -KOLKATA (IA-K), Kolkata, WB INDIA &

BHARATI VIDYAPEETH (Deemed to be University), Pune, INDIA

Endorsed/Sponsored by

AAAAI and Center for Global Health, University of Colorado.USA.
email: 2022daai@gmail.com APPLICATION FORM : YEAR 2022

FULL NAME: (IN BLOCK CAPITALS

DATE OF BIRTH

SEX

NATIONALITY

PERMANENT ADDRESS

PRESENT ADDRESS:

Your preferred address for communication:

PERMANENT ADDRESS

PRESENT ADDRESS

Phone Number

Telephone No

How did you come to know about this program? **

DAAI website

Medical Journal

Other Friends/Colleagues

Newspaper

If through Newspaper/ Medical Journal, kindly specify the name:

Application Fee / DD Details:

DD Date:

DD Number:

Amount: Rs.2000/-

Bank Name:

While filling the following sections A-E, add additional sheets wherever the information exceeds the space provided**

A. EDUCATION:

	INSTITUTION	UNIVERSITY	FROM(DATE)	TO(DATE)	SUBJECT	DEGREE
PG Degree
PG Diploma
MBBS
Pre-Medical

* SUBJECT: Respiratory Medicine, TB & Chest Diseases, General Medicine, Paediatrics, ENT, MBBS etc

AWARDS & HONORS**:

WORK EXPERIENCE:

i)Mention your current working position, institution, and date of date of joining **

Date of joining:

Previous Employments**

S.No	INSTITUTION & ADDRESS (Most recent ones first)	CATEGORY #	DESIGNATION	FROM (DATE)	TO (DATE)
1
2
3
4
5
6

# CATEGORY: A. Government Medical College B. Government Service (Non-Teaching) C. NGO & Private Organization D. Mission Hospital

C. PAPER PRESENTATIONS & PUBLICATIONS** :

D. RESEARCH ACTIVITIES**:

E. CONFERENCE AND WORKSHOPS ATTENDED**:

F. PLEASE ANSWER THE FOLLOWING QUESTIONS IN A PARAGRAPH EACH:

(Please attach separate sheets)

Enumerate in 100 words, how doing this course will enhance/change your practice?

This course will involve regular study, completion of assignments and patient evaluation, in addition to attending the quarterly physical contact sessions. Do elaborate on how you would create sufficient time (at least 1 hour daily) for study, in addition to your current responsibilities.

Is there a need for an 'allergy-asthma' specialty in your community/hospital? After completion of this course, do you foresee a need for your contribution as a specialist?

COURSE INFORMATION:

DAAI is a distance education program, offered by the Asthma Services (IAS) , a registered charitable institution in Colorado, USA and Bharati Vidyapeeth (Deemed to be University) Pune, Maharashtra, INDIA. The course is endorsed by 'Center for Global Health', University of Colorado, USA and also by 'American Academy of Allergy, Asthma & Immunology'. The course was formulated to train qualified specialists in both theoretical and practical aspects of the practice of Allergy and Asthma and related aspects of clinical Immunology. We believe the training would equip the trainees with the necessary skills to practice this specialty. Specialists with an MD degree or DNB or PG diploma in TB & Chest/Respiratory Diseases/ Pediatrics/ GeneralMedicine/ MS in ENT/MD Dermatology/MD Preventive Medicine/MD Pharmacology are eligible to apply. Candidates with an MBBS qualification with a proven record of academic practice in Allergy and asthma of at least 5 years may be considered, at the discretion of the selection committee. These candidates should substantiate their experience when they apply.

International, National and Local faculty will provide 4 one week contact programs at Basic study material shall be provided for reference. The candidates are expected to refer to additional materials as required and complete the assignments. On successful completion of the course, a certificate of proficiency will be granted by Bharati Vidyapeeth (to be Deemed University), Pune, INDIA and the International Asthma Services organization, Colorado, U S A.

DISCLAIMER:

** This course is not approved by NMC, India. This course is purely to enhance learning, skill and good clinical approach of the trainees and should not be used to proclaim any service or appointment .

In view of the unpredictable situation on account of the COVID-19 pandemic, if travel to attend is impossible or if government regulations preclude gathering, we shall conduct the sessions on a suitable web platform.

Note:The fee covers a reference Textbook of Allergy for the Clinician, 2nd edition” as well as a set of Basic Allergy Prick testing materials and all the handouts.

A) Indian Candidates:

DD to be drawn in favor of: 'NCD Immunomedicare Pvt Ltd' payable at Kolkata,West Bengal.

Tuition fees:	Rs. 65,000/-
Final examination fees:	Rs. 10, 000/-
Materials and supply:	Rs. 25, 000/-
Total:	Rs.1, 00, 000/-

Payment by NEFT:

Account name	ALLERGY ASTHMA EDUCATIONAL RESEARCH AND INITIATIVE
Bank Information	CANARA BANK, N R I BRANCH 10-14, 1ST FLOOR, THE ROYAL CROWN, SANGAM TALKIES ROAD, ASHOKA RD, LASHKAR MOHALLA, MANDI MOHALLA, MYSURU, KARNATAKA-570001
PH. NO	0821-2528213, 9483502309
Account Number	2309201000011
IFSC CODE	CNRB0004838

B) Overseas Candidates:

Total fee amounting to the equivalent of US $ 2000/- payable to 'International Asthma Services' by;

Certified check. This can be handed over at the beginning of the 1 st Personal Contact Session.

PayPal or Credit Card at: www.globalchestinitiatives.org (Please add USD150 towards the 'Flipcause' fees for the transaction).

POINTS TO NOTE:

The application form should be filled up legibly. Additional sheets could be added when required .

Copies of MBBS, Diploma & MD certificates should be attached with the application. Incomplete applications may be disqualified.

Selected candidates are required to remit the fee in full before commencement of the course

The candidates should bear their expenses for attending the contact programs towards; travel, boarding, lodging etc.

The last date for the receipt of completed application forms is January 15th 2022, 5 PM IST). The short listed candidates shall be intimated by January 22nd 2022, 5 PM IST and are expected to let the DAAI coordinator know by email their final decision to join by January 29th 2022 5 PM (IST)

The short listed candidates would be required to sign an undertaking that they would comply with all the requirements of the course, before they are considered for the final selection. The organizers may hold an interview of shortlisted candidates if required. The conduct of the interview shall be at the sole discretion of the organizers. The fees paid by the selected individuals will not be refunded if they choose not to join or discontinue the course.

If any or all the contact sessions are not possible due to COVID-19 restrictions, they will be conducted via an online platform.

The course is likely to commence in Mid February 2022 (This is the amended date that has been changed due to the current Covid Pandemic situation).

INSTRUCTION

All completed application forms need to be sent with the following:

1. A COPY OF YOUR RESUME / C.V
2. ATTESTED COPIES OF THE DEGREE CERTIFICATES (MD/MS/DNB, Diploma & MBBS)
3. TWO RECENT PASSPORT SIZE PHOTOS
4. D.D FOR RS. 2000/- (NON-REFUNDABLE) - APPLICATION FEE IN FAVOR OF

'NCD Immunomedicare Pvt Ltd' PAYABLE AT Kolkata, WB. COMPLETED APPLICATION FORM WITH ALL THE STATED DOCUMENTS NEEDS TO BE SENT BY COURIER TO:

Ms JANET JAYASEELI

DAAI course Coordinator

No: 6/A, 4th cross street

Jaanipoonthottam

R N palayam

Vellore. 632001

Tamilnadu. INDIA

Phone: +91 9789344835

email:2022daai@gmail.com