Amref Health Africa Internship Application Form

1. Identification
Family name

Chandrakumar

First name

Abin

Gender

Male

Date of Birth

27/08/1992

Nationality

Indian

Marital Status

Unmarried

Nature of internship

Normal Internship

(Normal internship, Volunteer,

Researcher). Please indicate one

2. Contact Information
Postal Address

Al Shifa College of Pharmacy, Kizhattoor, Poonthavanam

P.O, Perinthalmanna, Malappuram Dist. Kerala-679325

Home phone

NIL

Mobile phone

+919497475089

Fax

NIL

Email address

abinchandrakumar@gmail.com

3. Education
Please give the exact name and location of each secondary and post-secondary educational
institution that you have attended, the years that you attended, and the certificate, degree,
diploma or certificate(s) that you were awarded by each. Please also indicate the major or
main subject of study at each institution.

Institution
KENDRIYA
VIDYALAYA
AFS AKKULAM

Location
KERALA

Years
attended
12

AL SHIFA COLLEGE OF
PHARMACY

KERALA

Degree,
Diploma or
Certificate
Awarded
+2

STILL
STUDYING

Major / Main
Subject of
Study

PHARM.D

4. Languages
Please list all languages that you can speak, read or write and identify your skill level for
each (e.g. native, advanced, intermediate, or beginner)
Language
ENGLISH

Read
YES

Write
YES

Speak
YES

HINDI

YES

YES

YES

MALAYALAM

YES

YES

YES

5. Computer Skills
Please identify all software applications that you are familiar with and check the appropriate
box to indicate your skill level with that product.

SPSS

Basic
YES

Intermediate
-

Advanced
-

MICROSOFT OFFICE

YES

Software/Program

6. Other Skills / Abilities / Competencies

Please identify any other relevant skills, abilities or competencies that you possess (i.e.
operations research, M&E, editing, proposal writing, website or database development,
programming, graphic design, fundraising, cataloging, etc.)

Skill / Ability / Competency

PROPOSAL WRITING

Basic
BASIC

Intermediate

Advanced

YES

DRUG INFORMATION PROVISION

YES

PATIENT COUNSELLING

7. Work Experience
Please describe any previous work experience that you have had, giving details of your
duties and achievements.

From / To
NIL

Employer
NIL

Job Title
NIL

Duties & Achievements

NIL

8. Areas of Interest
a. In which functional or programmatic area would you like to conduct an
internship with Amref Health Africa?

Programme Area

YES

NO

Reproductive Health and Family Planning

Adolescent & Youth Reproductive Health
Maternal & Child Health
Malaria
Water and Sanitation
HIV/AIDS & TB
Clinical Diagnostics
Monitoring and Evaluation
Research
Communication
Information Technology
Finance
HR & Administration

b. What are your career goals and how will an internship with Amref Health Africa
help you to achieve them?
My career goal is to serve humanity as a competent Clinical Pharmacist and I will jot be able
to achieve the aim without training programmes and internsips during my study period.
Such programmes are sure to refine the core competencies of students such as mine so that
by the time I pass out next year I can directly enter into the Health Care arena rather than
further spending time for exploring training programmes and waiting for acceptance to the
programmes which will lead to lack of routine interaction with my competencies and blunt
my skills. Iam very much interested in the extent of healthcare training programmes being
conducted in the African continent by organisations such as WHO, Amref, Red Cross etc and

has also applied for the Pharmacovigilance programmes of WHO to be held in Accra, Ghana
and the Vaccine Pharmacovigilance programmes.

c. Why would you like to conduct an internship with Amref Health Africa (as
opposed to another organization)?
9. The main emphasis in my country is on the physicians and the emerging profession of
clinical pharmacy doesnt get adequate share of training or exposure to optimize their
output. Therefore I rely on programmes such as AMREF internship for supporting us. My
policy is to aquire knowledge for refining my competencies through whatever means it
comes. AMREF through its large network in the continent serves as an ideal platform for
serving as a Launchpad to my profession

a. Why should Amref Health Africa select you for this internship what special
attributes, skills or abilities do you bring to the table?
Iam a 5th year Pharm.D student and 5 years of study especially in the one of the leading
NABH accredited superspeciality hospitals of my state of Kerala. We regularly attend ward
rounds here from our 2nd year onwards with emphasis on clinical activities like patient
profile completion, checking for interactions and notifying physicians, active participation in
therapeutic decision making, surveillance of ADR, Medication Reconciliation programmes
and bedside In-patient counseling. Drug Information services are also provided by us under
the supervision of perceptors to the health care professionals in the hospital. In any health
care setting, not only me, but any student in our college would be able to perform the
above mentioned activities with finesse. My focus on Anticoagulants as part of my 5th year
academic project also adds further depth into my capacities.
10.Proposed Dates for Internship
(Please note: Amref Health Africa accepts interns for a minimum of three (3) months and a
maximum of six (6) months

NOVEMBER 2015
FEBRUARY 2016
From: __________________
To: __________________
11. Statement of Understanding & Agreement to the Conditions of the Internship
I understand that, should I be accepted as an intern at Amref Health Africa, the following
conditions will apply:

a) Status. Although I will be an Intern and will not be considered a member of the
regular Amref Health Africa staff, I shall still be subject to all of Amref Health Africas
rules and policies.
b) Financial Support. I will not be paid a salary by Amef Health Africa, but may
receive a modest monthly stipend. I am personally responsible for all of my visa,
travel and living costs during my internship with Amref Health Africa, including my
travel costs from and to my home/ home country (if applicable), and the cost of my
accommodation, meals and other living expenses during the internship.
c) Medical/Health/Travel Insurance. Amref Health Africa accepts no responsibility
for costs arising from illnesses or accidents which occur during the internship. I will
therefore have in place adequate medical/health/travel insurance to cover such
events, should they happen. The following health/travel insurance company will
cover me during the internship period.
Insurer (name, contact information):
AL SHIFA HOSPITAL STUDENT MEDICAL INSURANCE SCHEME (operated by Shifa
Institute of Medical Sciences under Shifa Trust)
For international interns (please note that internship with Amref Health Africa
cannot be approved unless you provide this information).
d) Visa. Amref Health Africa will issue a letter confirming my acceptance as an Intern
and the conditions governing my internship so that I can obtain a visa for my
internship. However, I am personally responsible for obtaining the visa that is
required for my country of internship.
e) Confidentiality. As an intern, I will respect the confidentiality of information that I
collect and/or am exposed to at Amref Health Africa. No reports, papers, internal
documents or information of any kind obtained from Amref Health Africa may be
published or shared externally without the explicit written authorization of Amref
Health Africa.
f)

Intellectual Property Rights: In case of research interns, Amref Health Africa shall
be entitled to all property rights, including but not limited to patents copyrights and
trademarks with regard to material, which bears a direct relation to or is made in
consequence of the services provided to the Foundation by the intern. At the
request of the Foundation the intern shall assist in securing such property rights and
transferring them to the Foundation in compliance with the requirements of the
applicable law.

I agree to all points in Section 11 above. I also certify that the information and statements
that I have made in all sections above are true, complete and correct to the best of my
knowledge.

6/12/2014

Signed: ________________________________________ Date: _____________________