Public Service Fund (PSF) Support to Attend the MINT Forum (Minties) Or TNT And/Or Forum

Public Service Fund (PSF) Support to Attend the MINT Forum (MINTies) or TNT and/or Forum (MINTies-to-be)

2016 Montréal, Québec, Canada

Application to be submitted by 5p.m. GMT on15thJune, 2015

[A] APPLICATION FOR PUBLIC SERVICE FUNDS – CONTACT INFORMATION / APPLICANT’S RESPONSE / REVIEWERS NOTES (to be filled out by MINT PSF Committee members only)
A.1 / Which event(s) are you planning to attend (TNT, Pre-forum workshops*, Forum*)? Please list all that apply.
*Open to current MINT members only / TNT
Pre-Forum workshop*
Forum / Total score (B1, B4 and B5):
A.1.2* / If you are applying for support to attend a pre-Forum workshop, please let us know which workshop you hope to attend. A place will be held for you until July 17th; you must contact the MINT administrator personally to reserve your place and arrange payment, whether or not you receive PSF support.[rfg1] / Pre-forum Workshop A
Pre-forum Workshop B
Pre-forum Workshop C
Pre-Forum Workshop D
A.2 / Name
A.3 / Address
A.4 / Telephone contact number& email
[B] ELIGIBILITY CRITERIA / APPLICANT’S RESPONSE
B.1 / We encourage people to attend TNT/Forums that are closest to them physically. Please let us know why it is important for you to attend this particular TNT and/or Forum? Please provide as much detail as possible. / 1point
2 points
1 points
B.2 / Please indicate the various costs of attending the TNT and/or Forum, and indicate the total cost involved. Please fill in only the costs that pertain to your application. / Airfare/travel cost:
Accommodation cost:
TNT registration fee:
Forum registration fee:*
Other cost (specify):
TOTALcost:
B.3 / Check up to 3 items you would most like to receive support for. Note: requests may be granted only partially. / Airfare/travel
Accommodation
TNT registration fee
Forum registration fee*
Other (specify):
TOTAL requested: / Total amount requested:
B.4 / Please describe the reasonswhy you are applying for this financial support (eg. lack of agency funding, financial setback, etc ).Please provide as much detail as you are comfortable sharing. / 1 point
2 points
3 points
B.5 / Other comments/information (eg, please let us know how you give, or are willing to give, back to the MINT community (ex., joining a committee), or other ways you contribute (offering free MI services, etc.) / 1 point

[rfg1]This will probably change as we develop the mechanism for holding spaces for PSF applicants