CPS Early Career Leadership Development (ECLD) Scholarship Application

Please fill out the following fields and make sure you read the rules.
All fields marked with a * are required. There is no save option. Application must be completed in full. Prepare your information and documents ahead and then send in this form.

Are you an Early Career Pharmaceutical Group (ECPG) member *
Are you a Community Pharmacy Section (CPS) member? *
Are you a Community Pharmacist employee or owner? *
Select your graduation year from your first degree: *
Have you previously received any financial support, in any form, from the FIP Foundation for Education and Research? *
Country: *

Other Country: *

STEP 2

Title: *
First / Given Name(s): *
Last / Family Name: *
FIP Membership Number: *
Street Address: *
Area code:
City: *
Region: *
Email: *
Telephone: *
Mobile:
Have you attended an FIP Congress before?
if yes, in which year(s):
Curriculum Vitae (maximum 2 pages pdf format):*  
Letter of interest (pdf):*  
First letter of recommendation (pdf):*
From supervisor, manager, employer or dean of school		  
Second letter of recommendation (pdf):*
From national professional pharmacy or pharmaceutical organisation		  
Certificate of the first degree (jpg, png, pdf): *  
A good quality photo: (jpg/png) *  
Signature
By signing this application, the applicant agrees and understands that any monies received or paid as a result of this application are subject to the following terms:
  1. All information contained in this application is truthful and accurate to the best of your knowledge, and no relevant information has been withheld.
  2. Funds granted as a result of this request are expended for the attendance of the Annual FIP Congress as described in this application.
  3. The International Pharmaceutical Federation and the FIP Foundation for Education and Research have the right to make available and to use all data and photos provided in this form for the purposes of managing the grant and to publicize the outcomes of the project.
  4. The applicant is obliged to keep the International Pharmaceutical Federation and the FIP Foundation for Education and Research informed about any changes concerning the proposed application in a timely manner.
  5. In the event of winning a congress scholarship, the applicant is obliged to submit a final report as described in the guidelines.
Applicant’s name: *
Place: *
Date:
Signature: *
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How did you get to know about the CPS ECLD scholarship? LinkedIn: FIP, FIP-Foundation, ECPG
Other LinkedIn pages
Websites: FIP, FIP-Foundation, ECPG
FIP-Foundation, FIP, ECPG etc
Colleagues

Consent:

I affirm that this application for the CPS Early Career Leadership Development Scholarship is original and has been independently developed by the author. I further affirm that I have read and understood the rules of the competition.


In order to comply with privacy regulations in the European Union we will need you to provide consent before we can accept your application for the following items:

By checking this box I agree that the FIP Foundation for Education and Research may process and share my application (including all attached documents) for review purposes with an evaluation committee consisting of members selected by the FIP Foundation for Education and Research.
By checking this box I agree that my application and personal details will be kept on file for 12 months.

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Partners

FIP works for

Our contact details Foundation for Education and Research
Andries Bickerweg 5
2517 JP The Hague
Netherlands

foundation@fip.org