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Application Form for Early Career Pharmacists and Pharmaceutical Scientists Innovation Grant
Part I. Project Identification
Please note that you have to give the project a name. Please provide a title that is clear, precise and informative
A summary of the project in a non-technical language for publicity:
Please describe the issue(s) or problem(s), objectives, methods and the expected outcomes of the project in simple, non-technical terms (max. 200 words)
Part II. Applicant Identification
A. Details of the applicant
Please attach a short Curriculum Vita (CV) of the applicant. If this is a group application, please submit a short CV of the person who will represent the applying group. (pdf)
Please attach a Mentorship acceptance/support letter (pdf)
Full name
FIP Membership Number
Street address
Zipcode
City
Region
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua & Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia & Herzegovina
Botswana
Brazil
British Virgin Islands
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
CapeVerde
Cayman Islands
Central African Republic
Chad
Chile
China
China Taiwan
Colombia
Comoros
Congo (Dem. Rep. of the)
Congo (Rep. of)
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
French Guiana
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bisau
Guyana
Haiti
Holy See (Vatican City State)
Honduras
Hong Kong SAR, China
Hungary
Iceland
India
Indonesia
Iran, Islamic Rep.
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea (Dem. People's Rep. of)
Korea (Rep. of)
Kosovo
Kuwait
Kyrgystan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao SAR, China
Macedonia FYR
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mexico
Micronesia, Fed. Sts.
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Samoa
San Marino
Sao Tomé & Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovak Republic
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia & South Sandwich Islands
South Sudan
Spain
Sri Lanka
St Kitts & Nevis
St Lucia
St Vincent and the Grenadines
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad & Tobago
Tunisia
Turkey
Turkmenistan
Turks & Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Wallis & Futuna Islands
Yemen
Zambia
Zimbabwe
E-mail
Telephone
Part III. Project Description
Main themes for the activities
The topics listed below are examples. The applicant is free to define new themes/subjects applicable to the project. Please tick a maximum of 3 boxes.
International cooperation
Emerging trends in practice
Research & model designs
Rural healthcare development
Access to medication
Vaccination services
Healthcare promotion
Managing disease outbreaks
Anti-drugs/substance abuse
Disadvantaged people
Compounding & drug development
Research & model designs
Diagnostics & clinical practice
Pharmaceutical analysis
Biotechnology & pharmacogenetics
Epidemiology & post market research
Drug targeting & drug delivery
Herbal & traditional medicines
Academia & pharmacy education
Continuous professional development
E-pharmacy & new technologies
Novel community pharmacy services
Medication management practices
Professional development & promotion
“Seven star” pharmacist
Other (1) specify
Other (2) specify
Other (3) specify
Project Significance and objectives
Describe why the research is significant and clearly describe the aims and objectives of the project (Max. 150 words)
Proposed duration of the project:
Long-term - longer than 6 months
Remember that the project
must be completed with measurable results in the 1-year funding period
.
Scientific Background / Problem Statement (with references):
Please provide a rationale for the project and what is known about the topic. (Max. 150 words)
Project Impact:
Describe possible outcomes resulting from project implementation that will have direct clinical application. These outcomes should be measurable. (Max. 100 words)
Methods
Describe the proposed methods, intervention (where necessary) and all steps required to achieve or evaluate the defined outcomes. (Max. 300 words)
How your solution will work in practice
Information and data that demonstrates the feasibility of the project, detailing the resources required. (Max. 150 words)
Pharmacists’ role in the project
What qualifications will be important? What is the role of the pharmacist in this particular project? (Max. 50 words)
Budget Proposal
How do you plan to use the grant? Remember that the grant prohibit application that requires sources of funding beyond the ECPG grant. Please consider breakdown the list into personnel, consumable supplies, travel expenses, other expenses, and administrative costs to start.
Mentorship
Identify your research mentor, provide their name, title and affiliation, and contact information. Do not forgot to attach the mentorship acceptance/support letter to this application. Include the URL for the profile of your mentor.
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:
Please note that this application form will be the applicant’s project entry in the Grant database of the International Pharmaceutical Federation (FIP) Early Career Pharmaceutical Group (ECPG). By signing this form, the applicant grants FIP the right to publicise the outcomes of the project. To expedite the processing of this form, please fill it in completely and correctly. Should you have any questions, please do not hesitate to contact the ECPG Steering Committee at ECPG@fip.org
All information contained in this application is truthful and accurate to the best of your knowledge, and no relevant information has been withheld.
Funds granted as a result of this request are expended for the project described in this application.
The International Pharmaceutical Federation and its Foundation have the right to make available and to use all data provided in this form for the purposes of managing the grant and to publicize the outcomes of the project.
The applicant is obliged to keep the International Pharmaceutical Federation and its Foundation informed of any changes concerning the proposed project in a timely manner.
In the event of winning the Grant, the applicant is obliged to submit reports and updates as required by the International Pharmaceutical Federation.
I affirm that this application for the Early Career Pharmaceutical Group’s Grant for Professional Innovation is original and has been independently developed by the author. I further affirm that I have read and understand the rules of the competition.
Applicant’s name
Place
Date
Submit
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Our contact details
Foundation for Education and Research
Andries Bickerweg 5
2517 JP The Hague
Netherlands
foundation@fip.org
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