The European Society of Contraception and Reproductive Health
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Home
About
Aims
Committees
Transparency
Medals
Partners
Statutes, Rules & Policies
History
Education
Webinars
COVID-19
Journal
Training Improvement Programme
WebLibrary on sexuality education
WebLibrary on abortion
Statements
Congress presentations
Links
Grants
Events
News
Member
Minutes assembly
Benefits & Categories
ESC DocMatter Community
Login
Become a member
Contact
Educational courses
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Education
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Grants
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Educational courses
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Step 3
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Step 4
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Step 5
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Step 6
A. Name of the applicant requesting the funding
Name of applicant
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Job title
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Street
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Number
your full name
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City
your full name
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State / Province
your full name
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Postal / Zip Code
your full name
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Country
your full name
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Phone Number
your full name
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Email
email
Short CV
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/
250
B. Proposed course or meeting
Is the person responsible for the project different to the person named in box A?
Yes
No
Name of person
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Job title
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Street
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Number
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City
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State / Province
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Postal / Zip Code
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Country
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Phone Number
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Email
email
C. Background of the project – narrative summary
Title
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Sector in the area of contraception, sexual and reproductive health
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Comprehensive description
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200
When would it start / finish?
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20
Where will it take place – country / town, establishment?
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20
3 learning objectives
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Who will be the audience?
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20
What outcomes will be measured?
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50
Attach a planned evaluation form to be used by the participants to rate the speakers and course content.
Attach a planned evaluation form to be used by the participants to rate the speakers and course content.
Attach a planned evaluation form to be used by the participants to rate the speakers and course content.
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Choose file
Attach the proforma you plan to use to evaluate the course from the organisers’ point of view.
Attach the proforma you plan to use to evaluate the course from the organisers’ point of view.
Attach the proforma you plan to use to evaluate the course from the organisers’ point of view.
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Choose file
Do you foresee any reasons (political, climatic, etc) why this project may be adversely affected?
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/
200
D. Financial related information
How much are you requesting from ESC?
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Are there other partners or organisations supporting this same course?
Yes
No
If YES - name the other partners who will support this course
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200
How much money is required for the course in total?
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Have you already obtained any funding or still awaiting a response towards this project?
Yes
No
Are you still awaiting a response towards this course? Give details below.
Yes
No
Items required for this course
Total amount requested from ESC
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Name of partners
Total amount requested from partner(s)
0
/
Any comments
Total amount requested from partner(s)
0
/
Total amount requested from ESC
Total amount requested from ESC
0
/
Total amount requested from partner(s)
Total amount requested from partner(s)
0
/
Add any additional information here
Add any additional information here
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/
The ESC may not be in a position to fully fund all applications; you must indicate whether / how part funding may impact your course.
more details
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100
Who will oversee the budget & keep accounts? Provide name, title, contact number and email address
more details
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Note: The ESC retains the right to be refunded any unspent money from the grant.
E. Previous funding from ESC
If you or your department has received funding from ESC for a project or course before, please give details of the date of funding, contact person and title of project or course.
more details
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/
F. Follow up
We, as responsible agents for this project, agree to the following 8 points:
I/We agree that all monies will be spent appropriately
I/We agree to work with the nominated Mentor
I/We agree to advise you at the earliest time if this project is delayed or cannot be completed
I/We agree to provide an interim report(s) part way through the project and a final report to the ESC within 6 months of the end of the project.
I/We agree to provide the ESC with an interim budget(s) and a detailed budget at the end of the project. NOTE funding will be awarded in stages and will be dependent on appropriate reporting.
I/We agree to provide receipts for monies spent if requested.
I/We agree that if we need to make any significant changes to the duration, contents or funding of the project after it has been awarded, I/we will advise the nominated mentor.
I/We (the applicant) agree to acknowledge the ESC as a donor in any publications, submission of abstracts and oral communications resulting from this project. Please inform the ESC Office where and when the data is to be presented and/or published and note that ideally any manuscript should be sent to the ESC journal in the first instance.
I/We (the applicant) agree to acknowledge the ESC as a donor in any publications, submission of abstracts and oral communications resulting from this project. Please inform the ESC Office where and when the data is to be presented and/or published and note that ideally any manuscript should be sent to the ESC journal in the first instance.
First Name 1
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Last Name 1
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First Name 2
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Last Name 2
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Submission date of this form
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Questions? ESC Central Office:
info@escrh.eu
/ Tel.
0032 2 582 08 52
Submit
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