International Association for Hospice & Palliative Care

IAHPC Fellows Program Application

This is an ongoing program, so there are no deadlines for applications unless stated. However, we need enough time to review your application and prepare the required paperwork in case it is awarded. Applications should be received no later than 3 months in advance of the expected date of travel.

Before applying, applicant must have received an invitation from the institution that will serve as the host during the visit.

Applicant and host BOTH must be a current IAHPC members. To join the IAHPC click here.

Applicant details

Given Name of Applicant *

Surname Name of Applicant *

IAHPC Membership Number *

To locate your IAHPC number click here.

Address *

City *

State/Province

ZIP/Postal code

Country *

Email *

Please attach a recent photograph of yourself (head shot only) to accompany the grant (PDF or JPG formats only / 2 MB of max file size) *

Please upload a copy of you recent CV (2 MB of max file size) *
Use this Word document to create your CV. Insert your relevant information as instructed in the CV Template, save the Word document and upload the document into the Travel Fellows application.

Trip Details

Departure Date *

mm-dd-yyyy

Return Date *

mm-dd-yyyy

Host details

Name of Host Institution *

Host Address *

Host City *

Host State/Province

ZIP/Postal Code

Host Country *

Host Phone

Host Fax

Host Contact Person *

Host Email *

Host IAHPC membership number *

Please upload an official letter on the institution letterhead that is signed and dated by a representative from the host institution (PDF or JPG formats only / 2 MB of max file size) *

Activities

Proposed Teaching and Clinical Activities *

List Objectives and outcomes you want to achieve *

Amount requested in USD

Travel Expenses (airfare, ground transportation, etc.)*
The IAHPC team will use online travel websites such as Expedia and Kayak to determine amount of airfare provided

Other Expenses *

Donor(s)

Amount

Comments