ITLS Reduced Fees Request Application

ITLS Reduced Fees Request Application

The request for consideration for reduced Course Management System (CMS) fees applies to all ITLS Chapters and Training Centres. This will also encompass training centre or chapter applicants who wish to have a virtual site visit due to financial hardships.

Approval Authority: ITLS Board of Directors
Policy Office of Primary Interest: ITLS Finance Committee
Enquiries: ITLS Executive Director and ITLS International Office

As a global not-for-profit organization, ITLS recognizes that in order to support the growth of Chapters and Training Centres in low-income and Lower-middle-income economies, a policy must be in place that would allow these Chapters and Training centers to apply for reduced costs, which will in turn be used for administrative costs in offering ITLS courses. ITLS also recognizes the need for virtual Chapter and Training Center site visits for those applicants who cannot afford to bring an ITLS International site visiting team to a CONUS or OCOUNS.

After reviewing the ITLS Reduced Fees Policy and criteria, please complete the application for requesting reduced fees.

Chapter/Training Centre Information

1. Chapter/Training Centre Name

2. Contact Full Name

3. Contact Email Address This question requires a valid email address.

4. Contact Telephone Number This question requires a valid email address.

5. Contact Mailing Address Line 1

6. Contact Mailing Address Line 2

7. City/Town

8. Province/State

9. Country

10. Postal/Zip Code

11. Website

Country/Student Landscape

15. Please tell us about your country:

16. Student education/professional base:

17. Average wage of your student base:

18. Cost of living:

19. Funding for ITLS training comes from:

20. Do you know of any similar programs to ITLS being offered in your country:

21. Course/Students Trained and Forecasted Information

Space Cell	Year	# of Students	Comments
Provider – Basic	Provider – Basic: Year	Provider – Basic: # of Students	Provider – Basic: Comments
Provider – Advanced	Provider – Advanced: Year	Provider – Advanced: # of Students	Provider – Advanced: Comments
Provider- Combined	Provider- Combined: Year	Provider- Combined: # of Students	Provider- Combined: Comments
High Threat	High Threat: Year	High Threat: # of Students	High Threat: Comments
Pediatric	Pediatric: Year	Pediatric: # of Students	Pediatric: Comments
Duty to Respond	Duty to Respond: Year	Duty to Respond: # of Students	Duty to Respond: Comments
eTrauma	eTrauma: Year	eTrauma: # of Students	eTrauma: Comments
eTrauma Completer	eTrauma Completer: Year	eTrauma Completer: # of Students	eTrauma Completer: Comments
Access	Access: Year	Access: # of Students	Access: Comments

22. Course/Students Trained and Forecasted Information

Space Cell	Year	# of Students	Comments
Provider – Basic	Provider – Basic: Year	Provider – Basic: # of Students	Provider – Basic: Comments
Provider – Advanced	Provider – Advanced: Year	Provider – Advanced: # of Students	Provider – Advanced: Comments
Provider- Combined	Provider- Combined: Year	Provider- Combined: # of Students	Provider- Combined: Comments
High Threat	High Threat: Year	High Threat: # of Students	High Threat: Comments
Pediatric	Pediatric: Year	Pediatric: # of Students	Pediatric: Comments
Duty to Respond	Duty to Respond: Year	Duty to Respond: # of Students	Duty to Respond: Comments
eTrauma	eTrauma: Year	eTrauma: # of Students	eTrauma: Comments
eTrauma Completer	eTrauma Completer: Year	eTrauma Completer: # of Students	eTrauma Completer: Comments
Access	Access: Year	Access: # of Students	Access: Comments

Chapter/Training Centre Specific information

23. What is your organizational funding model?

Space Cell	Rate	Cost per Student (without Discounts)	Cost Delta
Provider – Basic	Provider – Basic: Rate	Provider – Basic: Cost per Student (without Discounts)	Provider – Basic: Cost Delta
Provider – Advanced	Provider – Advanced: Rate	Provider – Advanced: Cost per Student (without Discounts)	Provider – Advanced: Cost Delta
Provider- Combined	Provider- Combined: Rate	Provider- Combined: Cost per Student (without Discounts)	Provider- Combined: Cost Delta
High Threat	High Threat: Rate	High Threat: Cost per Student (without Discounts)	High Threat: Cost Delta
Pediatric	Pediatric: Rate	Pediatric: Cost per Student (without Discounts)	Pediatric: Cost Delta
Duty to Respond	Duty to Respond: Rate	Duty to Respond: Cost per Student (without Discounts)	Duty to Respond: Cost Delta
eTrauma	eTrauma: Rate	eTrauma: Cost per Student (without Discounts)	eTrauma: Cost Delta
eTrauma Completer	eTrauma Completer: Rate	eTrauma Completer: Cost per Student (without Discounts)	eTrauma Completer: Cost Delta
Access	Access: Rate	Access: Cost per Student (without Discounts)	Access: Cost Delta

Chapter/Training Centre Overhead Costs

24. What external factors should ITLS consider when determining your application for reduced fees? Specifically, does your country have a history of hyper-inflation, currency devaluation, governmental price controls, inadequate infrastructure or other technological limitations that could affect the ITLS course offerings?

25. What is the maximum fee that your government (local/federal) will cover for training courses if participants are government employees?

Growth Strategy

Please provide us your growth strategy and plan in regard to the length of time required or rationale for reduced fees.

26. Please provide us your growth strategy and plan in regard to the length of time required or rationale for reduced fees.

27. As the Chapter/Training Centre authorized signing official, I hereby acknowledge that I have completed the Reduced Fees Request Application to the best of my ability, providing accurate and truthful information.

Clear

Signature of

28. Please upload any additional documents which will support your reduced fees application. (Example: budgets, letter of support, etc.)

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