Fundamentals Scholarship

Scholarship Application - Intensive HIV Fundamental Course

Clinicians from resource limited settings can apply for a scholarship to attend the Intensive HIV and Co-infections Conference in Hong Kong. 31 May - 3 June 2017.

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* 1. Your demographic and contact details

Family name

Given name

Country on which you work

Your clinical role in HIV management

Your position title

Your employer/company/institution

Your email

Your mobile/cell phone

Your supervisors name

Your supervisors email

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* 2. Please describe your current role in HIV HIV Management. Priority will be given to clinicians early in their career who are looking to develop their skills in this areas. (limit 2000 characters)

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* 3. Please describe your current role in hepatitis b management. (limit 2000 characters)

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* 4. Please describe your current role in hepatitis c management. (limit 2000 characters)

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* 5. Please describe your current role in the management of sexually transmissible infections. (limit 2000 characters)

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* 6. Please tell us a little about your current clinical setting and patient load, tick as many as are true for you

I work in a hospital setting

I work in a community clinic setting

I see more than 10 people with HIV each week

I see between 10 - 50 people with HIV each week

I see more than 50 people with HIV each week

Many of my patients are co infected (viral hepatitis, STI, TB etc)

A small number of my patients have other issues affecting their health (MSM, sex work, drug use, trans gender, homeless, mobile, poor)

Many of my patients have other issues affecting their health (MSM, sex work, drug use, trans gender, homeless, mobile, poor)

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* 7. I am seeking the following learning from attending this course. (limit 5000 characters)

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* 8. I am prepared to participate fully in the course by agreeing to do the following, tick as many as are true for you)

complete limited pre-reading set before the course

present a case from my clinical experience

attend all course sessions

attend all APACC conference sessions

complete a return home plan

complete a course evaluation during the course - leading to a Certificate of Attendance

complete a course assessment after the course - leading to a Certificate of Competency

contribute to the Regional Network CME and on-line learning portal

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* 9. Please describe the type and level of support you will require to attend this course. For people already registered for teh APACC . If you are not yet registered for APACC go to question 10.

I am already registered for the APACC Conference

I need accommodation for the additional 2 days to attend this course

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* 10. Please describe the type and level of support you will require to attend this course. Complete this question if you are not already registered for the Asia Pacific AIDS and Co-infections Conference, tick as many that are true for you.

I am not registered for APACC and will need a registration scholarship to attend

I will need an accommodation scholarship to attend the course and confernce

I will need an economy return airfare from my airport of origin to Hong Kong

I will need a per diem to cover living expenses while in Hong Kong

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* 11. Please indicate any other sources of funds you might be able to access to assist with your attendance at this course. Sharing costs will be looked on favorably. (limit 1000 characters)

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* 12. Are you preapred to be considered for a partial scholarship?

yes

no - I have no other source of support

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