AMEE Student Initiatives Grant - Application form

  1. General information

Activity title
Starting and Ending dates
Leader person
Should be a student / Name
Background
e-mail
Phone
Contact person
Should be a student / Name
Background
e-mail
Phone
Other members of the team
Please insert more lines if necessary / Name
Background / (institution/curricular year)
Name
Background / (institution/curricular year)
Organization / Institution
(if applicable) / Name
Address
e-mail
Phone
URL/webpage
Requested AMEE contribution
  1. Activity Description

Activity format
/ status / For ex: conference, workshop, training
Is it ongoing, previously organized
Problem statement / Why is this activity relevant in terms of health profession education? What problem(s) are you tackling?
Overall aim / Objectives / What is the overall aim of this activity? What are the specific objectives?
Strategy / Methodology / What is your strategy to achieve the overall aim and objectives?
Timeline and team responsibilities / Please insert a table with detailed timeline and indication of who will be responsible for each step.
If you prefer you can add a separate file.
Team members and respective tasks / Please indicate the role /responsibility of all team members. If in addition to the team members any other entities or persons are involved please indicate their roles.
Partners
(if applicable) / Please explain the contributions expected form each partner.
Measuring impact / What will be the immediate and long-term impact of your activity? Please describe the indicators you will use to measure the impact of your activity (qualitative and quantitative / immediately and long term effects).
Purpose of requested funding / What exactly will the AMEE funding be used for? How will it make a difference for your activity?
Sustainability / How will the project continue without AMEE funding? How will you ensure continuation of the activity? How will your project continue to improve?
Outreach potential / How will your activity lead to generalizable knowledge? Do you have any plans for publication/presentation of results? Is there any multiplication plan?
  1. Budget

Please provide a detailed budget, including other funding sources. Please note that AMEE financial contribution is limited up to 1000 GBP for each application round and may be decided to be spread among multiple applications.

  1. Expenses

unit / Estimated price in GBP / AMEE funding
1.
2.
3.
4.
  1. Other Sources of Funding (valued but not compulsory)

  1. In-kind contributions

IV other Information

Other relevant information you want to add

Please submit your application in .doc(x) and a .pdf by the deadline of 15th of December 2016 23.59 GMTto . Late applications will not be accepted.

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Please notice that each section may be enlarged or reduced by deleting or adding lines (you are allowed to remove the explanatory questions). Full applications cannot exceed the maximum of 4 pages (without changing the font, font size, column width or general page settings).

Any applications exceeding the page limit will not be accepted.