Bursary Application Form : Australasian Division of the IAP

BURSARY APPLICATION FORM TO ATTEND THE 49^thANNUAL SCIENTIFIC MEETING OF THE AUSTRALASIAN DIVISION OF THE IAP

Please read the below information carefully before applying.

Only Applications from Trainees/Pathologists residing in the following Countries/Territories can apply for the grant – Cook Islands, Federated States of Micronesia, Fiji, French Polynesia, Kiribati, Nauru, New Caledonia, Niue, Palau, Papua New Guinea, Republic of Marshall Islands, Samoa, Solomon Islands, Tonga, Tuvalu, and Vanuatu.
Applicants who have been offered any bursary/scholarships/grants by any division of the International Academy of Pathology (including USCAP) or by the Royal College of Pathologists of Australasia (RCPA) in the last 3 years are ineligible to apply.
All applications should include a CV.

Please complete all information

Bursary Application

Personal Information

Name(Required)

Title First Last/Family

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Postal Address(Required)

Street Address Address Line 2 City State / Province / Region Postcode / Zip Country

Daytime Phone Number(Required)

Mobile / Cell Phone(Required)

Email(Required)

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Do you reside in any of the listed Countries - Cook Islands, Federated States of Micronesia, Fiji, French Polynesia, Kiribati, Nauru, New Caledonia, Niue, Palau, Papua New Guinea, Republic of Marshall Islands, Samoa, Solomon Islands, Tonga, Tuvalu, and Vanuatu.(Required)

Yes

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Have you applied for our bursary previously and been rejected an Australian Visa?(Required)

Yes

Year visa rejected(Required)

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Have you got a valid passport to travel to Australia(Required)

Yes

Passport Date of Issue(Required)

Passport Expiry Date(Required)

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Academic Information

Please supply details of your academic qualification including undergraduate / post-graduate study in Anatomical Pathology.

Qualifications

Qualifications	Institution	Completed Date	Actions

There are no Qualifications.

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Employment Information

Please supply all details of your employment.

Employment

Position	Date From	Date To	Employer Details	Duties	Actions

There are no Positions.

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Supporting Information

Please outline the potential benefits you would gain by attending this meeting.

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List any/all bursaries/scholarships/grants that you have been awarded in the last 3 years.

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Cover Letter and CV

Both a Cover Letter and CV are required.

Files(Required)

Drop files here or

Accepted file types: doc, docx, pdf, Max. file size: 250 MB, Max. files: 2.

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Declaration

Declaration(Required)

Yes

I certify that the details contained in this application are correct to the best of my knowledge and that I have not been offered any bursaries/scholarships/grants by any division of the International Academy of Pathology or by the Royal College of Pathologists of Australasia in the last 3 years.

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BURSARY APPLICATION FORM TO ATTEND THE 49th ANNUAL SCIENTIFIC MEETING OF THE AUSTRALASIAN DIVISION OF THE IAP

Bursary Application

Personal Information

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Academic Information

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Employment Information

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Supporting Information

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Cover Letter and CV

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Declaration

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BURSARY APPLICATION FORM TO ATTEND THE 49^thANNUAL SCIENTIFIC MEETING OF THE AUSTRALASIAN DIVISION OF THE IAP