WIOMSA Proposals MARG-III - TRAVEL GRANT

Applicants are requested to fill in the following form. The information requested should be typed or entered into the required fields below and where additional information is required, a separate attachment will need to be uploaded to this application. You will be notified by email on successful completion of the submission.

For any information contact:
The Executive Secretary.
Email: secretary@wiomsa.org

PART I: SUMMARY OF THE REQUEST

TITLE OF THE EVENT *

Family Name *

Other Names *

Mailing Address *

Office Phone *

Mobile *

Fax *

Email Address *

Nationality *

Date of Birth *

Sex *

Male

Female

Are you a paid member of WIOMSA? *

Yes

Have you been awarded a MARG grant before? *

Yes

If Yes, which one? And when? *

Did you publish the supported research project? *

Yes

If Yes, list the publication *

Name of your Institution *

Head of Institution *

Address of your Institution *

Present position

Title of your Current Post *

Years of Service *

Type of Organisation *

Specify Type of organization *

EDUCATION INSTITUTION 1 NAME *

STUDY PERIOD 1 *

DEGREE OBTAINED 1 *

MAJOR FIELD OF STUDY 1 *

EDUCATION INSTITUTION 2 NAME *

STUDY PERIOD 2 *

DEGREE OBTAINED 2 *

MAJOR FIELD OF STUDY 2 *

EDUCATION INSTITUTION 3 NAME *

STUDY PERIOD 3 *

DEGREE OBTAINED 3 *

MAJOR FIELD OF STUDY 3 *

Meeting / Conference Type *

If \"Other\", please specify *

Will you present a Paper? *

Yes

If Yes, then what is the title of your presentation *

Name and address of the organizers of the event *

Contact person *

Contact Telephone *

Contact Fax *

Contact Email *

Have you attended any meetings/ conferences in the last 12 months *

Yes

If Yes, then provide details

Title of the event 1 *

When Event 1 occurred *

Location of Event 1 *

Title of the event 2 *

When Event 2 occurred *

Location of Event 2 *

Title of the event 3 *

When Event 3 occurred *

Location of Event 3 *

Description of the meeting/conference, placing it in the broader perspective with reference to its relevance to your research work or your thesis and expected results from your attendance to the event

Justification for Attendance Attachment *

Name of Local Currency *

Rate of exchange to US$ *

Travel (return) between your country and the institution (by air, most economical route) *

Per diem *

Total Cost *

Total support requested from WIOMSA *

Source(s) of other support(s) *

This application is endorsed and the facilities of the institution including the accounting services will be provided to the applicant in accordance with the requirements of the MARG Programme.

Name and Title *

Position of Head of Institution *

Place *

Expected departure date (dd/mm/yy) *

Please enter expected date of departure from nearest airport

A signed letter to be attached here. *

PART II: SUPPORTING DOCUMENTS

Instructions

In addition to the form please provide the following supporting documents
i) Curriculum Vitae – not more than 2 pages, including your recent scientific publications and research projects.
ii) Confirmation of Abstract Acceptance – Letter of acceptance of your abstract from the organizers.

Curriculum vitae, including your recent scientific publications and research project *

Confirmation of Abstract Acceptance - Letter of acceptance of your abstract from the organizers. *

Proposal Submissions

MARG-III – TRAVEL GRANT