Application for Reevaluation of Theory paper(s) (Use separate forms for each candidate)

Date: ____________________

To,

The Chairperson

_____________________________________________________,

Dear Sir / Madam,

Our Fellowship Candidate named __________________________________ took the IAP Neonatology Fellowship Exam on ___________________ held at _________________________, and obtained the following marks –

Theory - _______ / 200

Practical - _______ / 300; Clinical case studies - ______ / 160

Overall - _______ / 500

He / She were not declared PASSED based on the above marks.

We would like his theory paper(s) I / II / I and II to be re-evaluated by the IAP Neonatology Chapter. Kindly arrange for the same.

We are submitting a DD of Rs 250 / 500 for evaluation of one / both Theory papers. Kindly inform us of the result as soon as it is available.

Truly,

________________________________________    ___________________________

Signature of Institute Head                                     Signature of Fellowship Coordinator