Application form

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* 1. About you

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* 2. What is your ADEA membership number?

(Applicants must be a financial member of the ADEA for at least twelve months at the time of application)

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* 3. What is your Remoteness Area category?

(Applicants must be located in rural/remote Australia. ADEA members who are residing in categories ranging between RA2 to RA5 are eligible. To check the category of your Remoteness Area, please visit the Department of Health website)

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* 4. Have you received a travel grant from ADEA to attend ADEA conferences, i.e. ADC or branch conferences, in the previous two years?

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* 5. Have you received financial support from another source to attend ADC2022 or a meeting in association with ADC2022?

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* 6. Why is it important for you to attend ADC2022? (Maximum 200 words).

Please be specific and provide as many details as you can to demonstrate the benefits of attending ADC2022 for your practice and professional development. 
In addition, are you there to meet an expert or attend a specific session? 
Have you been making any contribution to the program? For example, presenting your abstract, chair a session, member of the program organising committee, etc.

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* 7. What will prevent you from financially supporting your attendance to ADC2022? (Maximum 200 words).

Please be specific and provide as many details as you can to demonstrate your challenges in attending ADC2022 without this grant.

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* 8. Please provide an estimate of your budget and details of expenses to attend ADC2022.

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* 9. How did you hear about the Pharmaco Travel Grant? (please tick all applicable option(s))

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* 10. If your application is successful, do you agree to provide ADEA with a 200-word reflective article that outlines the benefits of attending ADC2022 for your practice in diabetes education?

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* 11. If you have received an approval letter from your workplace indicating that you are available to attend ADC2022, please upload that letter here.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
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* 12. If you have submitted abstract(s) for ADC2022, please upload the confirmation letter here.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
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* 13. If you are involved in presenting a symposia/masterclass/workshop, please upload the confirmation letter here.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
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* 14. If you are attending meeting(s) with ADEA committee(s)/special interest group(s)/working party(ies), please upload the invitation here.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
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Please click on the 'Submit' button below to submit your application. If you don’t click on the ‘Submit’ button, this means your application form will not be received and you will not receive any communication from the Grant Management Team.

The Grant Management Team will contact all applicants by 17th July with the outcome of your application.
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