Apply for a Scholarship Part I Applicant - International Academy of Aviation and Space Medicine

Scholarship Application Form

Guidelines for Scholarship Applicants

Scholarship funds are intended to cover tuition and will be sent directly to the academic institution and not to the scholarship recipient. The intent is to support training in the specialty of Aviation and Space Medicine rather than courses where Aviation and Space Medicine is only a small component.

Individuals wishing to apply for a Scholarship should submit an application by completing the information below and pressing the ‘submit’ button. The information will be held in confidence by the Secretary General of the IAASM and be reviewed by the Chair and Members of the IAASM Scholarship Committee and Members of the IAASM Council.

The Application is in two parts. You should complete the first part and the second part should be completed by a sponsor who will support your application by means of a recommendation. You should ensure that both parts are submitted by 31^st July, the closing date, to give sufficient time for review prior to the meeting of the Scholarship Committee in early September. Late or incomplete applications will not be accepted. Scholarship winners will be notified within a month of the Fall meeting. The Scholarship winner(s) must start their training within 2 years following the award of the Scholarship

All financial values should be stated in either US Dollars or New Zealand Dollars.

Note 1: Before applying you should contact the institution where you intend to pursue your studies and find out if an English test is required. If so, the test must be taken and passed before applying for the Scholarship.

Note 2: Scholarships are not granted for training that has already been undertaken; all proposed training should commence after 1^st January of the year following the application.

NOTE 3: If your application is successful the transfer of grant monies will be subject to you signing a scholarship agreement with the International Academy of Aviation and Space Medicine which confirms the conditions for the use of the scholarship and the support you can expect from the Academy.

For further information, please contact the Chair of the Scholarship Committee by email: scholarship@iaasm.org.

PART I – TO BE COMPLETED BY THE APPLICANT

NOTE: All fields are required. If not applicable, so state.

A) PERSONAL INFORMATION AND CURRICULUM VITAE

Title(*)

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E-mail(*)

Invalid email address.

Full name (as on passport)(*)

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Place of birth / Nationality(*)

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Phone number (include country code)(*)

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Date of birth(*)

/ / This field is required.

Home address(*)

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Work address(*)

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Education ( institution attended, time period )(*)

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Have you applied previously for an IAASM scholarship and in what year? (*)

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Career activities since graduation ( organization, activity, time period )(*)

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Current role and employment/occupation(*)

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Membership of aviation and space medicine and other relevant organisations(*)

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Publications(*)

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Honours and awards received(*)

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Military service(*)

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Languages spoken(*)

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Future aviation and space medicine career plans(*)

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B) SCHOLARSHIP REQUEST

Year of scholarship application(*)

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Course name(*)

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Name of institution(*)

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Is an English language test required for this course?(*)

YesNo

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Programme details (including Lectures, Practical sessions, Seminars/Lab sessions)(*)

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Please attach a syllabus if possible.
IMPORTANT: The only accepted file type is PDF.

Please upload the documents

Note: Please state if any modules are provided by distance learning or virtually.

Assessment (include modules, credits)(*)

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Institution Address(*)

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Start date of intended course(*)

/ / This field is required.

End date of intended course(*)

/ / This field is required.

Tuition fees(*)

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Course Director (name, position and email address)(*)

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Please note that the following expenses are not awarded as part of the scholarship grant: accommodation and food; books and educational materials; visa; travel and transportation; costs associated with a research project.

C) FINANCE REQUESTED

Note: Please give as much detail as possible.

Registration Fee(*)

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Tuition Fees(*)

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D) FINANCIAL DECLARATION

Your personal savings and investments(*)

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Family support(*)

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Your gross annual salary(*)

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Other sources of annual income and amounts(*)

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Value of capital assets held (including property)(*)

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Liabilities(*)

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Government support (including benefits)(*)

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Loans (current and intended; state sources)(*)

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Other scholarships awarded(*)

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State in detail why you consider that you should receive financial support from the academy (*)

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If the value of your proposed course exceeds NZD32,000 please describe how you would fund the excess amount(*)

This field is required.

In submitting this form, I agree
- that, if I am selected as the successful candidate and receive a scholarship grant, I will make every effort to keep in contact with the Academy and notify the Chairman of the Scholarship Committee and the Secretary General of my career progress by sending an update to them at least once per year.
- I have read the notes and have made a complete and accurate declaration of my income and assets.
- to inform the Academy if there is any material change to my financial circumstances.(*)

I agree

Please check this box if you agree

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