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IPSF Development Fund 2016-2017

1 round of Event Grant Application World Congress 2017


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Guidelines for Development Fund Applicants


Please read carefully before completing the application form
1. Background
The main goal of the Development Fund is to give each and every pharmacy student an equal
opportunity to fully participate in IPSF activities. This opportunity is also intended to help promote IPSF
within their Schools of Pharmacy and countries. The Development Fund was initially created with the
aim of supporting students who were unable to attend an IPSF event because of financial reasons.
Currently the Development Fund may also be used to pay the IPSF Annual Membership Fee of
organizations from low or lower middle income countries (as defined by the World Bank) and
developing nations (as defined by the United Nations), to financially support IPSF activities undertaken
by members and participation in IPSF events and to award Student Exchange Program Grants.
This is the official application form for participation in the following IPSF event during 2017:
1. The 63rd IPSF World Congress, Taipei, Taiwan, 31st July 10th August 2017
(http://ipsf2017.org/)
Completing this application form means that you have decided to embrace this opportunity and play an
active role in IPSF, locally, nationally, and internationally. Congratulations!
However, it is essential that applicants understand this grant is given to a student to allow him/her
promote IPSF in their home country on returning from an IPSF event not as a free holiday.
These guidelines were designed to ensure that potential applicants are fully aware of the selection
process and also accept the expectations, restrictions and consequences of an application .
This grant is awarded to attend the IPSF World Congress as stated above and will cover the World
Congress registration fee unless otherwise specified, or upon other request. This round of event
grants is solely for those attending the IPSF World Congress. A second call for event grants will
be made at a later date for those attending regional symposia.
2. Completion of the application form
Please ensure the application form is completed accurately with any other information relevant to the
selection process being added to the form. Every section must be completed for the application form
to be considered valid. Applicants must submit an electronic version of the application form prior to the
closing date (the 15th of February 2017 11:59pm GMT+0) before any applications will be considered
complete. The electronic version should be emailed directly to the Development Fund Coordinator
(df@ipsf.org).
3. Procedure of the application
For World Congress Phase 1 registration applicants, you may either:
1. Complete the registration process for World Congress as per usual and pay your
registration fee
When you apply for the Event Grant, include in your correspondence whether youve
already registered.
If you are successful in your grant application, your registration fee will be reimbursed at
World Congress by the Reception Committee.

IPSF Secretariat: Andries Bickerweg 5, P.O. Box 84200, 2508 AE The


Hague, The Netherlands.
Tel: +31-70-302 19 92 - Fax: +31-70-302 19 99 - Email: ipsf@ipsf.org -

2. Apply for the Event Grant and wait till annoucement of the successful grant applicants
before registering for World Congress, in this case, we will inform the reception committee
to waive your registration fee.
Note that if you opt to wait and are not successful for the grant, you will not be granted
a place in the Phase 1 registration if the quota is already filled.
This option is to assist with applicants, who may not have the funding to attend the World
Congress without the Event Grant.
For pharmacy students who are not eligable to register during phase 1 of World Congress
registration but intend to register in phase 2 or phase 3 of the registration period, you are also
required to apply for the grant by the same deadline, the 15th of February 2017 11:59pm GMT+0,
which will be prior to your world congress registration. If your grant application is successful, you will
be granted the event grant when you register.
4. Who is involved in the DF grant selection procedure?
4.1. The decision-making committee, who will consider valid applications, is the Development
Fund Committee which consists of three member representatives from three different countries, the
IPSF Treasurer and the Development Fund Coordinator, who chairs the committee.
This committee corresponds via email and discusses issues relating to the selection process and ways
to optimize the impact of the Development Fund grants at local and international levels.
Successful applicants will be notified by the Development Fund Coordinator before the 28th of
February 2017.
4.2. The applicant must be currently studying for their pharmacy undergraduate degree (first
pharmacy degree). An applicant may be an IPSF member through an IPSF Member Organization
(Full Member or Member in Association) or as an Individual Member.
Selected or not, an applicant is expected to provide accurate information and add any additional
information that would be relevant in the consideration of the application form.
If selected to receive the grant, a recipient is expected to:
Take an active part in IPSF activities and projects during and after the IPSF event attended.
If possible, deliver a presentation based on pharmacy practice and studies in their home
country during the IPSF event attended.
Produce a report addressed to the Development Fund Committee and to the IPSF Executive
detailing a review of the experience; what has been learnt and which IPSF projects/activities
are planned to be implemented in their country and why.
o This report must be sent no later than 1 month following the IPSF event attended.
Based on the report recipients may be required to write an article about pharmacy in their
country and/or the experience gained from attending the respective IPSF event, to be
published in the IPSF News Bulletin, IPSF Newsletter or on the IPSF website.
Keep in regular contact with the new IPSF Executive Committee after the congress to
maintain correspondence regarding what has been done in their country in order to maximize
the impact and benefits the experience will provide to other pharmacy students in that country.

IPSF Secretariat: Andries Bickerweg 5, P.O. Box 84200, 2508 AE The


Hague, The Netherlands.
Tel: +31-70-302 19 92 - Fax: +31-70-302 19 99 - Email: ipsf@ipsf.org -

5. Grant coverage and criteria


The awarded grant will cover the World Congress registration fee unless otherwise specified,
or upon other request.
For the 1st round of event grants, if the World Congress registration fee is awarded, IPSF will pay the
registration fee on behalf of the successful applicants during the registration period. For other
circumstances upon request, the grant will be paid by bank transfer after participation in the event and
submission of the required documents. In special cases the grant may also be paid to the recipient at
the event by cash.
The total number of grants awarded will be decided after the deadline for receipt of applications and
will be dependent on the total number of quality applications received and on the grant budget
available.
Priority will be given to:
i.
Applicants from low and lower middle income countries (as defined by the World Bank) or
from developing countries (as defined by the United Nations);
ii.
Those who have served IPSF as a Contact Person, Student Exchange Officer,
subcommittee member or in some other way contributed to IPSF Projects;
iii.
Students in their last year of study
iv.
Those who will be attending an IPSF event for the first time and/or are the only
representatives from their countries.
Special attention will be given to expenses of the trip and how reasonable they are, motivation letter
and if other sponsors were approached.
Representatives of organizations who will apply for IPSF membership at the World Congress
may also apply for this grant.
6. Issues to be taken in the consideration
6.1. Visas: It is essential applicants establish whether they require a visa to attend the respective
IPSF event and begin the necessary steps in order to be ready to apply quickly, in the event that the
application is successful and a grant is awarded.
No grant will be given to an applicant who fail to obtain the visa(s) required traveling to the
country where the IPSF event will occur.
Sadly, this issue often prevents recipients from actually attending the IPSF event. So please, be
prepared if a visa is required and collect any relevant documentation and information needed for a
visa request in advance to accelerate the procedure within the Embassy.
6.2. Sponsors: Applicants should look for sponsorship as soon as they start thinking of going to the
IPSF event. National, local and private bodies often have a budget to support students with these
kinds of initiatives. The Development Fund exists to help but rarely gives a grant that covers all of
the expenses involved. It is advised that initial steps with potential sponsors are begun
immediately as it often takes a long time period before an answer is received - one might even be
surprised and obtain more sponsorship than was originally thought!

IPSF Secretariat: Andries Bickerweg 5, P.O. Box 84200, 2508 AE The


Hague, The Netherlands.
Tel: +31-70-302 19 92 - Fax: +31-70-302 19 99 - Email: ipsf@ipsf.org -

7. Situations and Consequences


To avoid any misunderstanding of the procedure, misuse of the grant or reduction in the grants
awarded each year, this section has been added to dissuade any potential applicant from hiding any
relevant information or from providing incomplete or false information on their application form.
It is an applicants responsibility to inform the Development Fund Coordinator of any changes in the
information stated in the application form as soon as the applicant is aware of any new information. It
is recommended that all applicants retain a copy of their application form to remember what has been
stated in the application. If any changes of circumstances occur after submitting the application form
please inform the Development Fund Coordinator as soon as possible. Any applicant awarded a DF
grant and later found to have misused funds will not be eligible to receive any DF Grant in the future.
If the grant has been paid before the misuse has been identified then the applicant must pay the grant
fully or partly back to the IPSF Development Fund as determined by the Development Fund
Committee and IPSF Executive.
The Development Fund Committee reserves the right to withdraw or reduce any grant given to
an applicant in the event of any of the following situations arising:

Information relevant to the selection process was hidden from the Development Fund
Committee by the applicant.
Information stated by the applicant is later identified as being inaccurate or false and the
applicant failed to notify the Development Fund Committee about the necessary changes
required to the application.
New information concerning the financial situation of the applicant (and the relevant
member association, when applicable) was not provided (such as a new sponsor, more
money available than was originally stated, bigger amount of funds allocated by the
association to send the applicant to attend the event etc.).
Failure to submit the required documentation and/or receipts or submission of incomplete
documentation.
Other situations at the discretion of the Development Fund Committee.

IPSF Secretariat: Andries Bickerweg 5, P.O. Box 84200, 2508 AE The


Hague, The Netherlands.
Tel: +31-70-302 19 92 - Fax: +31-70-302 19 99 - Email: ipsf@ipsf.org -

IPSF Development Fund World Congress Event Grant: Application form 2017
Every Section of this application form must be completed in order to be valid. An application will only
be considered if sections A, B, C and D have been completed, and the declarations electronically
signed by inserting the relevant name.
Please complete the application form as a Microsoft Word Document and return this electronically via
email to the Development Fund Coordinator at df@ipsf.org before the 15th of February 2017 11:59pm
GMT+0. When returning your application, please rename the file to include the event you wish to
attend and your name, for example: WC2017 DF Application Form - Name

SECTION A
PERSONAL DETAILS
Full Name

Mr / Mrs / Miss

Full Address
Country
Nationality
Telephone Number
Fax Number
Email
Current Passport Number
Valid until:
Visa Requirements
Cost of Visa (Euros)
Time Required To Obtain Visa
Contact Information of relevant
embassy in your country
Contact person in the embassy you
have spoken to and title

IPSF Secretariat: Andries Bickerweg 5, P.O. Box 84200, 2508 AE The


Hague, The Netherlands.
Tel: +31-70-302 19 92 - Fax: +31-70-302 19 99 - Email: ipsf@ipsf.org -

STUDY DETAILS
Name of School of Pharmacy
at which you are studying
Address

Qualification you will receive


Total length of course
Date of graduation (expected)

INVOLVEMENT WITHIN YOUR NATIONAL ASSOCIATION AND WITHIN IPSF


(Maximum 400 Words)

Word Count

IPSF Secretariat: Andries Bickerweg 5, P.O. Box 84200, 2508 AE The


Hague, The Netherlands.
Tel: +31-70-302 19 92 - Fax: +31-70-302 19 99 - Email: ipsf@ipsf.org -

FINANCIAL DETAILS
Your National Currency
Exchange rate on 1 Euro ()
Exchange rate on 1 Euro ()
Verified by Treasurer on 15th Feb 2017

[TREASURER TO COMPLETE]

Yearly Income (received during the previous 12 months)


Income Type

National Currency

Euro

Applicants Income
Scholarship/Grant Money
Loans, please specify
student or other
Fathers Income
Mothers Income
Family Allowance (money from family for
expenses)
Other sources of
income, please
specify

TOTAL
Yearly Expenditure (spent during the previous 12 months)
Income Type

National Currency

Euro

Rent or housing
Electricity, gas, water
Phone & Internet
Food & Groceries
Tuition
Books, stationary, school supplies
Clothing, shoes, personal hygiene
Other sources of
expenditure, please
specify

TOTAL
(Living expenses are considered as necessary costs for living that are paid by the applicant personally. For example food,
accommodation expenses (flat rent), electricity fees and study costs (books etc.) but not unnecessary costs like holidays)

Estimated travel and


visa expenses to attend
the IPSF event (state for
return journey)

National Currency

Euro

IPSF Secretariat: Andries Bickerweg 5, P.O. Box 84200, 2508 AE The


Hague, The Netherlands.
Tel: +31-70-302 19 92 - Fax: +31-70-302 19 99 - Email: ipsf@ipsf.org -

(Please complete the below table as appropriate detailing your estimated travel route and the
corresponding costs. Please note that only one row will need to be completed for a direct travel option.
However for a travel plan which involves a number of modes of transport each leg of the journey
should be listed on a separate row. For example: Row 1: Flight Amsterdam, The Netherland to Cairo,
Egypt; Row 2: Bus Cairo, Egypt to Hurghada, Egypt etc.)

Destination(each leg
of the journey on a
separate row)

Estimated Costs
(including return
travel)

Route and means of


Transportation

Source of the information


(Website/travel agency etc)
If you have an electronic
document please attach it

IPSF Secretariat: Andries Bickerweg 5, P.O. Box 84200, 2508 AE The


Hague, The Netherlands.
Tel: +31-70-302 19 92 - Fax: +31-70-302 19 99 - Email: ipsf@ipsf.org -

SPONSORSHIP DETAILS
State the names of any bodies in your country which you have already contacted for sponsorship,
when you contacted them and the actual or possible results of the request (s):
SPONSOR

CONTACT DATE

RESULT

IPSF can give advice about approaching sponsors in your home country. Applicants are expected to
try and find sponsorship from other bodies apart from the IPSF Development Fund, and to explain why
if this has not been done.

IPSF Secretariat: Andries Bickerweg 5, P.O. Box 84200, 2508 AE The


Hague, The Netherlands.
Tel: +31-70-302 19 92 - Fax: +31-70-302 19 99 - Email: ipsf@ipsf.org -

SECTION B
MOTIVATION
In this section applicants should detail their reasons for applying for the grant; specifically
their reasons for attending the respective IPSF event, and also describe how attendance at
such an event would benefit other pharmacy students in their home country. Please also state
any additional information that may be relevant to the selection process, especially details
relevant to the Priority criteria stated in section 5.
As this section is seriously considered during the selection process, applicants are reminded of the
importance of stating clear and realistic reasons for their participation, with a focus on the personal,
national and international impact an IPSF event experience may create. The length of this motivation
should be no longer than 400 words.

Word Count

IPSF Secretariat: Andries Bickerweg 5, P.O. Box 84200, 2508 AE The


Hague, The Netherlands.
Tel: +31-70-302 19 92 - Fax: +31-70-302 19 99 - Email: ipsf@ipsf.org -

SECTION C
STUDENT ASSOCIATION DETAILS
(To be completed by the President and Contact Person)
Name of your National Association

Address of your association

Name of the IPSF Contact Person


Can this association contribute to
your expenses

Yes

No

Are you an official delegate?

Yes

No

Are any other persons (graduated,


student, others) from your country
attending? If yes, are they,
a) Students from your
local student
association
b) Members of your
national
association

Yes

No

Yes

No

Yes

No

If yes, how much?

Names and positions of attending


persons

Name

Position

(Please insert more rows or attach an


additional page if more students are
attending)

For the application to be valid, the most recent audited balance sheet of the
association must be submitted with the application.
We declare that:
1. The information stated above in Section C is to the best of our knowledge complete and accurate.
2. In the event of any changes in the information stated above, we will notify the Development Fund
Coordinator, without delay to prevent the potential withdrawal of the grant (if the application is
successful).

IPSF Secretariat: Andries Bickerweg 5, P.O. Box 84200, 2508 AE The


Hague, The Netherlands.
Tel: +31-70-302 19 92 - Fax: +31-70-302 19 99 - Email: ipsf@ipsf.org -

LOCAL STUDENT ASSOCIATIONS PRESIDENT

Signature
Date
Email Address
NATIONAL PHARMACY STUDENTS ASSOCIATIONS PRESIDENT

Signature
Date
Email Address
IPSF CONTACT PERSON

Signature
Date
Email Address

IPSF Secretariat: Andries Bickerweg 5, P.O. Box 84200, 2508 AE The


Hague, The Netherlands.
Tel: +31-70-302 19 92 - Fax: +31-70-302 19 99 - Email: ipsf@ipsf.org -

SECTION D
LETTER OF SUPPORT FROM SCHOOL OF PHARMACY
To be completed by the Head of School or Dean of the Department of Pharmacy at which the applicant
is studying. The Head of School or Dean should confirm that the statements made by the applicant in
Sections A and B of this form are complete and accurate therefore they must have seen a copy of
the completed application form. The letter of support should be attached as a separate Word
Document.

IPSF Secretariat: Andries Bickerweg 5, P.O. Box 84200, 2508 AE The


Hague, The Netherlands.
Tel: +31-70-302 19 92 - Fax: +31-70-302 19 99 - Email: ipsf@ipsf.org -

SECTION E
DECLARATION
I declare that:
1. I have read the guidelines and both understand their meaning and respect them.
2. I accept the consequences undertaken by the Development Fund Committee if I fail to respect
these rules
3. The information stated is to the best of my knowledge, complete and accurate.
4. I will notify the Development Fund Coordinator of any changes in the information stated above
without delay by email at df@ipsf.org.
5. I will make every effort to stimulate active interest in IPSF within my country.
6. I accept the fact that, in the case of my application being successful, the Development Fund
Committee reserve the right to withdraw the grant if any of the situations stated in the section
Situations and consequences of the above guidelines occurs.
7. If this application is successful, I will respect the duties of the applicant stated in the
guidelines written at the beginning of the application form (as per Section 4.2.)
APPLICANT

Signature
Date

IPSF Secretariat: Andries Bickerweg 5, P.O. Box 84200, 2508 AE The


Hague, The Netherlands.
Tel: +31-70-302 19 92 - Fax: +31-70-302 19 99 - Email: ipsf@ipsf.org -

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