Reimbursement Subsidy Request Form for attendance at the World Stroke Congress (Oct 10-12, 2023) in Toronto, Ontario Survey

The StrokeCog Clinical Trials Training Platform and CanStroke Recovery Trials Platform are providing reimbursement subsidies for approximately 40 clinical trials staff (e.g., early career researchers (ECR), allied health professionals, nurses, and/or research clinical trial coordinators) working on stroke or vascular cognitive impairment (VCI) clinical trials to help them attend the World Stroke Congress (WSC) in Toronto (Oct 10-12, 2023), up to the maximum amounts detailed below.

Eligibility for funding subsidy from StrokeCog/CanStroke platform includes being a member of a stroke or VCI clinical trial team (e.g., early career researchers (ECR), allied health professional, nurse, clinical trial research coordinator) specifically working on a team involved in stroke and/or VCI clinical trials research at a Canadian institution (but excluding trainees, fellows, PI or QIs). Due to the limited amount of funding available, and depending on the number of requests, we reserve the right to limit how many individuals from the same clinical trial team/institution get subsidies. Note: ECR is defined as a researcher within five years of the date of their first independent academic appointment).

Attendees are responsible to cover all costs upfront (e.g., registration fees, travel, accommodations) and then submit for subsidy with proof of attendance after the congress. (but note - confirmation that they are approved for a subsidy will be sent prior to the congress)

Listed below are the maximum subsidies available, depending on your point of origin:
Outside of Ontario - $ 3,500
Within Ontario (but outside Toronto-region) - $ 3,000
Within Toronto - $ 500

Note: You must not be receiving funding from another source to cover the same costs, although you can combine funding if the actual costs exceed the subsidy.

TO REGISTER AND GET PRE-APPROVED for the StrokeCog/CanStroke platform reimbursement subsidy, please complete all questions below.

Note: This registration survey is only to request a funding subsidy from StrokeCog/CanStroke to attend the World Stroke Congress. You will also need to register directly at https://worldstrokecongress.org/ to register for the congress.

1.Name(Required.)

First Name

Last Name

2.Email Address (to be used for further correspondence)(Required.)

3.Re-enter email address (for verification)(Required.)

4.Present academic status(Required.)

Early Career Researcher

Allied Health Professional - PT, OT, SLP, RT, Other

Research Nurse

Clinical Trial Research Coordinator

Other (please specify)

5.Affiliation(Required.)

Name of Institution

Department Name

City

Province/State

Country

6.Supervisor - please list primary supervisor, and their institution(Required.)

Name of Primary Lead of Stroke/VCI Clinical Trial (i.e., your supervisor)

Primary Lead's Institution

7.Describe your research program and team, specifically, in which stroke/vascular cognitive impairment clinical trials your team is involved, and what specifically is your role on the trials team (up to 300 words).(Required.)

8.Describe how and why you would benefit from attending the World Stroke Congress in Toronto (October 10-12, 2023) (maximum 300 words).(Required.)

9.Are you planning to attend the entire program (Oct 10-12, 2023) ?(Required.)

Yes

Other (please specify)

10.Comments/Questions:

Please use this space if you have any comments or questions about the subsidies.

Notes regarding subsidies:
1) Travel origin refers to province that the person is working in and will be travelling from.
2) Travel and accommodations subsidies assume economy levels
3) Attendees are responsible for booking and paying for their own costs to attend the WSC, and then submitting with proof of attendance for reimbursement to farrell@canadianstroke.ca
4) Reimbursement will only be given to those individuals who signed up online PRIOR to the congress and received PRE-APPROVAL confirmation from StrokeCog. Approval will come directly from Farrell Leibovitch, Platform Director, CanStroke/StrokeCog.
5) Funding will be offered on a first-come first-served basis. We have limited funding, so apply early!
6) No later than August 31, we will start informing those who signed up whether or not there is funding available for them (and if so, confirm how much).
7) Depending on the number of requests, we reserve the right to limit the number of subsidies going to a trial team/institution, to increase the number of trial teams that can benefit.
8) You need to be a member of CanStroke/StrokeCog Platform to receive the subsidy - if not already a member, go to Platform Sign-Up to sign-up (no cost to join).

Please direct all questions regarding funding amount or eligibility to Farrell Leibovitch at farrell@canadianstroke.ca

Reimbursement Subsidy Request Form for attendance at the World Stroke Congress (Oct 10-12, 2023) in Toronto, Ontario

Pre-Approval Sign-up Form - please register by Sep 15