International Association for Hospice & Palliative Care

Traveling Fellows Host Application

This form is to be completed by a representative of the unit service which has invited the applicant for an IAHPC fellows to visit. Completing this form does not require any payment but it is mandatory for the application process.

The host institution must be either an IAHPC institutional member or a formal representative of the host institution must be an IAHPC individual member. If not, application for membership must be completed online.

Contact information

Name of host organization *

Address *

City *

State/Province

Zip/Postal Code

Country *

Website

Name of IAHPC member (institutional or individual) *

Name of person completing this form *

Position in institution *

Email *

Name of invited fellow *

Country where fellow lives and works *

Email fellow *

Proposed date of visit from *

mm-dd-yyyy

Proposed date of visit to *

mm-dd-yyyy

Expected Outcomes

Why is Travelling Fellow being invited to visit your unit /service? *

Outline the specific expectations which you have for such a visit *

Describe in detail the proposed schedule and plan for a Travelling Fellow's stay with your unit / service *

Provide detailed costs of accommodation and travel costs within your country *

Comments