Applications are accepted until 25rd April 2014
Part I: Introduction
The International Society for Quality in Health Care (ISQua), in collaboration with the World Health Organization
(WHO), is offering applicants from developing countries or countries with economies in transition, scholarship places
to attend the ISQua 2014 International Conference, which will take place in Rio de Janeiro, Brazil from 5th – 8th
October 2014.
The scholarships aim to identify and support up and coming ‘leaders’, who would benefit from the exposure and
hopefully take the opportunity to establish useful networks. Priority will be given to professionals who are relatively
junior in their career and whose organizations are considered least able to afford such an opportunity. The
scholarships do not target senior country officials working for well recognized institutions. These scholarships are
also available to those involved with Patients for Patient Safety.
The scholarship covers: the registration of the main conference programme (3 days of the conference with
lunches) and individual ISQua membership up until December 2014.
The Scholarship DOES NOT COVER
 expenses for travel, accommodation and additional meals*
 registration fees for additional programmes or activities
* A limited amount of travel support is available. See section 13 of the application form.
There are limited places so if you accept an offer of a scholarship you must commit to attending the whole
event – this is to be fair on those who applied but who were not successful.
Please note any application received after 25th April will not be accepted
Part II: Details of the application
Title:
First name:
Date of Birth (dd/mm/yyyy) _____
Last name:
Sex:
Male
Female
Contact details (For telephone and fax, please provide country and city codes)
Postal address …………………………………………………
………………………………………………
………………………………………………
2. Have your ever attended the ISQua conference?
3. Have you ever received an ISQua Conference
scholarship?
Telephone
Fax
Email
Yes, in what year ______________
No
Yes, in what year ______________
No
Comments: (if any) _______________________
________________________________________
4. How would you describe yourself?
a patient / consumer
a health professional
a student
other (please give details) _______________
________________________________________
5. What is your occupation?
6. Are you currently in paid work? (Are you employed?)
Yes
No
Comments: (if any) ________________________
________________________________________
7. If yes, what is your job title?
8. Please give details of your employer
Name of institution:
Contact address:
Govt/University
Private
NGO
Other (please specify) ……………..
Website:
9. How would you describe your job?
10. What are your main reasons for applying for the scholarship? (Why are you applying for a scholarship?)
11. How would attendance at the ISQua conference benefit your current work?
As the ISQua Conference scholarship covers the conference registration fee only, you need to seek funding from
other sources to support the costs of travel, accommodation and other expenses.
12. How will you find funding support for your travel and accommodation if you are awarded an ISQua Conference
scholarship?
Support from your organization (please attach a support letter from your supervisor)
From other funding sources (Please provide the evidence e.g. a letter of support)
Comments:
Part III: Your curriculum vitae and referees
13. To apply for travel support, please complete the following:
How many conferences will you attend this year:
Estimated cost of travel to Rio de Janeiro:
How much financial support can you expect from other sources:
14. Please attach your short curriculum vitae (CV) listing your present and past positions (in reverse order - starting
from the present or most recent job. (Maximum 2 pages)
15. Please provide names and contact details, including email address, of at least two referees (persons that we can
ask to comment on your application)
Please include details such as name, position, affiliated institutions, relation to you, telephone number and email
address.
Referee 1 (email is mandatory)
Referee 2 (email is mandatory)
I have read and understand the conditions of the scholarship.
Name _________________________________________________________
Signature _____________________________________________________
Date ____________________________