International Association for Hospice & Palliative Care

Traveling Scholars Application

This is an ongoing program, so there are no deadlines for applications unless stated. However, applications should be submitted to the IAHPC no later than 3 months in advance of the expected date of travel.

Applicant must be a current IAHPC member. If you need to join or renew your membership, click here.

Applicant Information

Given Name of Applicant *

Surname Name of Applicant *

IAHPC Membership Number *

To locate your IAHPC number click here.

How would you like to be addressed in communications and scholars program announcements?

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

Yes

Address *

City *

State/Province

ZIP/Postal code

Country *

Email *

Salutation *

Are you an MD? *

Specialty *

Current position/title *

Institution *

Number of years since graduation *

Number of years working in palliative Care *

Proportion of your current working time devoted to PC *

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). This photo will be attached to your IAHPC membership profile *

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 Scholars application.

Please upload a letter from your direct supervisor written in your institution letterhead (PDF or JPG formats only / 2 MB of max file size) stating that if you are granted this scholars, the institution gives you the authorization to travel and take the days to attend this activity. *

Activities

Name of Event / Meeting / Activity you wish to attend or participate *

Event City *

Event Country *

Event date from *

mm-dd-yyyy

Event date to *

mm-dd-yyyy

Provide the link to the event’s website

I attest that I understand the official language of the congress *

Name of sponsoring/host organization/institution (the name of the organization / institution who is producing the Event / Meeting / Activity you wish to attend) *

Event’s Contact Person *

Event’s Contact Person Phone

Event’s Contact Person Email *

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 traveling scholars program is to provide financial assistance to palliative care professionals to attend 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

This program offers funding for travel and registration only. You need to secure funding from other sources to cover additional expenses.

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 founds

Other donor(s) amount

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