International Association for Hospice & Palliative Care

IAHPC Scholarship Program Application

Applicant must be a current IAHPC member. Join or renew your membership.

Applicant Information

First (given) name *

Last (surname) name *

IAHPC membership number *

Find your IAHPC membership number.

City *

Country *

Email *

Current position/title *

Institution *

Number of years since graduation *

Number of years working in palliative care *

Your work time devoted to palliative care *

Attach a recent headshot of yourself (PDF or JPG only /max. file size: 2 MB) *

By submitting a photo, I confirm that I have read the authorization, release, and agreement, prior to its execution, and confirm that I am fully familiar with its contents.

Upload a copy of your CV/resume (2 MB of max file size) *
Use this Word template to create, save, and upload your CV/resume

Upload a letter from your direct supervisor on the institution's letterhead (PDF or JPG only/max. file size: 2 MB) stating that, if chosen, the institution authorizes you to participate *

Is your institution an IAHPC active member?
Your institution must be listed on the IAHPC members’ list.

Yes

Activities

Name of Event / Meeting / Activity you wish to participate in *

Modality *

Are you required to have a passport to leave and an enter the country of destination? *

Yes

If you are required to have a passport to travel and you do not have one, please stop completing this application and initiate the passport process with the corresponding official government office in your country.

Passport expiration date *

Are you required to have a visa to enter the country of destination? *
Check the Embassy page of the country of destination to find this information.

Yes

Are you required to have a transient visa if traveling through another country different from destination? *
Check the Embassy page of the country of destination to find this information.

Yes

Event City *

Event Country *

Event date from *

mm-dd-yyyy

Event date to *

mm-dd-yyyy

Event’s website URL

I confirm that I understand the official language of the congress/educational event I am applying to. *

I confirm that I have permission from my supervisor to participate in this virtual conference. *

I confirm that I am able to attend this virtual event regardless of the hour difference between my time zone and the time zone of the event. *

Using Speedtest please state your current Wi-Fi download and upload capacity.

Download speed *

Upload speed *

Name of sponsoring/host organization/institution that is producing the event / meeting / activity you wish to participate in *

Event contact person *

Event contact person email address *

Check if you will be presenting a poster or oral presentation (the IAHPC will contact the Event Contact Person to verify your abstract has been accepted to present a poster or oral presentation)

Name of poster/oral presentation *

IAHPC believes that palliative care workers, in addition to being health care providers, may also be effective agents of change in their own countries and settings.

The goal of the IAHPC Scholarship Program is to provide financial assistance to palliative care professionals to participate events that will enable them to improve palliative care in their settings. These should ultimately lead to better and adequate policies and/or institutional norms, increased access to palliative care as well as access to essential medicines for pain relief and palliative care.

In the space below describe your anticipated outcomes from participating in this event. Be specific on how you will use your new knowledge and skills to improve palliative care one or more of the categories below in your country, and/or municipality, and/or institution:

Education
Access to essential medicines
Care provision
Policies

Expenses in USD

Registration Costs *
Registration fee must match the registration fee listed on the event’s website

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

List other sources of funding for your trip (complete all that apply):

Own funds

Other donor(s) amount

Comments