Grant Application for IASP Chapters (IASP-03)

This application is for use by IASP chapters to request IASP financial support for a Visiting Professor to attend a chapter event. Please complete the form and return it to Valerie M. Evans by email: or fax: +1-202-524-5301.

Decisions to fund requests will be based on the availability of financial resources, benefit of proposed projects, and support for previous requests. Submitting an application is not a guarantee of financial support by IASP. Due to the large number of IASP chapters and limited funds, IASP will fund only one Visiting Professor to a chapter once every two years. The Visiting Professor must be an IASP member and will be required to show a short PowerPoint presentation as part of their lecture.

1. Name of Chapter
2. Contact Person
(Specify office held: President, President-Elect, Secretary, Treasurer, Other (give title, e.g., Committee chair)
3. Mailing address
4. Telephone
5. Fax
6. Email
7. Event information / Title:
Dates:
Location:
Main Topics:
8. Number of delegates expected to attend the meeting?
9. Name of proposed speaker (Include a copy of proposed speaker’s short form CV;1 page):
Topic of Lecture:
10A. Has proposed speaker already been invited?
______Yes ______No / 10B. Has proposed speaker accepted the invitation?
______Yes ______No
11. Accommodations, meals, other local expenses: The local chapter must make arrangements for funding local expenses (hotel, meals) from sources other than IASP. Please identify all other sources and amounts of funding (e.g., chapter funds, other association funds, pharmaceutical company, etc.) If approved, IASP will only cover airfare (lowest upgradeable economy) and will directly reimburse the speaker for that cost.
Activity / Detailed Description of Costs Including Source of Funding / Projected Cost
(Please indicate currency)
Airfare / If approved, IASP will only cover airfare (lowest upgradeable economy) and will directly reimburse the speaker for that cost.
Hotel
Meals
Other
12. Other relevant information (use additional space if necessary)
13.
Signature / Date