MfPH Workshop on Early Warning Systems for Emerging and Re-emerging Diseases Funding Application

This form can be used to apply for partial funding to participate in the "MfPH Workshop on Early Warning Systems for Emerging and Re-emerging Diseases" to be held at the Fields Institute in Toronto, Ontario, Canada on January 23-25, 2023.

Please note that the budget for this event is a less than MfPHest, so in order to maximize your chances of funding, please try to minimize your expenditures. Awardees will need to pay for their expenses ahead of time and get reimbursed after the festival. In selecting attendees for travel support, preference will be given to postdoctoral fellows and graduate students who have no alternative means of support.

We particularly encourage the participation of women and members of underrepresented minorities.

Important Dates

Please submit your application as soon as possible to be considered for funding. The deadline to submit this form is January 13, 2023 at 11:59 PM ET.

Application Process

Please fill in the form below. Applicants need to submit a CV, containing basic information such as degrees earned, current affiliations, and a list of publications. Graduate students can include relevant coursework, projects, grades, and any other information that the student feels is relevant to support their application.

Travel Support Requirements

Applicants are strongly encouraged to secure additional funding from other sources. Funds will be disbursed only in the form of reimbursements for actual expenses. A receipt is required for any expense reimbursed (e.g. airfare and hotel receipts).

The reimbursement will be sent as a cheque by mail six to eight weeks after receipt of an acceptable reimbursement form and supporting receipts.

Application Form Instructions

•   Fields with an * are mandatory.
•   This online application must be filled out completely and submitted. It is not possible to save a partially completed application and return to it later.
•   You may submit ONE .pdf file with your application no larger than 10MB. Please have this .pdf ready to upload when you start to fill out this application.
•   Once your application is submitted, a confirmation email will be sent to the email address you designated on your application.

Disclaimer: Unless otherwise noted, all responses are confidential, and will only be viewed by the organizers and administrative staff at the Fields Institute who are assisting in hosting the conference.

1. Contact Information.
Do not use BLOCK/ALL CAPITALS.

Honorific/Title

First Name *This question is required.

Last Name *This question is required.

Work Phone Number

Home/Personal Phone Number This question requires a valid number format.

2. Please enter your email address. *This question is required. This question requires a valid email address.

3. Please re-enter your email address. *This question is required.

4. Are you affiliated, for example, with a university, institution, organization, or company? *This question is required.

Please enter your affiliation (university, institution, organization, or company).
Do not use BLOCK/ALL CAPITALS.

Institution/Organization *This question is required.

Department (if applicable)

Street Address

Apartment/Suite/Office

City/Town *This question is required.

Province/State/Region

If you selected "Other" under Province/State/Region, please enter it here.

Postal Code/Zip Code

Country *This question is required.

5. Please enter your mailing address details below.
Do not use BLOCK/ALL CAPITALS.

Street Address *This question is required.

Apartment/Suite/Office

City/Town *This question is required.

Province/State/Region *This question is required.

If you selected "Other" under Province/State/Region, please enter it here.

Postal Code/Zip Code

Country *This question is required.

6. Demographics (This information will be used for statistical and reporting purposes internally and for funding partners, to improve the diversity of access to programming at the Fields Institute.)

Reference

Would you like to include your supervisor's contact information for reference?
We may contact them if needed when making funding decisions. *This question is required.

Supervisor Affiliation Details. *This question is required.
Please avoid using BLOCK/ALL CAPITALS.

First Name *This question is required.

Last Name *This question is required.

Email *This question is required.

Institution/Organization *This question is required.

Department (if applicable)

Country *This question is required.

7. Comments regarding your funding support application may be indicated below (150 word maximum): *This question is required.

8. Funding Estimates

Please provide the estimated breakdown of the travel costs (airfare, train, etc.) and the accommodation costs you would like to have reimbursed (Please note that you are expected to book the lowest travel & accommodation rates available) *This question is required.

9. Total Requested Amount of Funding Support. *This question is required.
Any reimbursement claims must adhere with Fields Institute Reimbursement Policies. It is the responsibility of the applicant to ensure that his/her funding request is consistent with these guidelines. This question requires a valid currency format.

Please enter the total requested amount of funding support in Canadian Dollars:

10. Additional Comments for the Organizers

Please upload your CV.

Please name your .PDF file: "LAST NAME, First Name.pdf"
The maximum file size is 10 MB. *This question is required.

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