UICC ASIA-PACIFIC CANCER SOCIETY TRAINING GRANT
Funded by the William Rudder Memorial Fund (Australia)
INTERNATIONAL CANCER FELLOWSHIPS
ADMINISTERED BY CANCER COUNCIL QUEENSLAND (Australia)
By submission of a formal application, the candidate confirms agreement to Guidelines for APCASOT
Applicants and Mutual Responsibility Guidelines for Hosts and Fellows.
Section A: Applicant Details
Family/surname:
Given names:
Date of birth:
Nationality:
Present position title with voluntary cancer society:
Since when (year):
Name and address of home institute (must be a voluntary
Cancer Society):
Telephone:
Telefax:
E-mail:
Name and title of home supervisor (who should also provide a hand signed letter of release on
organisational letterhead paper):
What is your primary language?:
What other languages do you speak?:
Qualifications
Please list the most recent qualification first.
Date of
Title of qualification
qualification
Current post
Date of post
(start - end)
Job title
Field of Study
Awarding body
Department & Institution
Previous positions held
Please list the most recent position first.
Date of post
Job title
(start - end)
Department & Institution
Academic Profile
Number of publications as per date of this application:
In English:
In another language:
Professional societies or associations of which you are a member:
Previous UICC Fellowship(s) Received, Project and Year (e.g. ICRETT 2004):
Member of the Association of UICC Fellows: Yes / No
Background
Please describe your work at a voluntary cancer society.
Section B: Project Description
This is the most important component of your application. It should be prepared by yourself and must not
exceed 2 pages. It must address all of the following criteria:
a. Purpose of Project (describe the key objectives to be achieved):
b. What transferable skills do you hope to gain and how will you apply these after the
Fellowship:
c.
Relevance of the project to the cancer problem in your country:
d. Relevance and potential benefit to activities in the home institute:
e. Facilities available upon return to continue the work, apply and disseminate the newly
acquired skills:
f.
Your qualifications and experiences in reference to this project
Funding from Sources Other than UICC
Have you applied to another funding source for support for the same project and period?
 No
 Yes, please give details:
Section C - Documentation checklist
Documentation checklist - please check that all documents as required have been addressed by placing
a tick in the appropriate box. Incomplete applications cannot be registered.
Applicant:
Home:
 Applicant’s rationale for chosen project

 Applicant’s curriculum vitae
Hand-signed Letter of Release on
organizational letterhead paper from home
supervisor
 Applicant’s publication list (if any)
Section D - Declaration
If this application is successful, I hereby declare that I shall return to my home institute at the end of the
fellowship. I certify that the foregoing statements are true and complete to the best of my knowledge. I
understand that any false statement is sufficient cause for rejection of this application or for cancellation of
a fellowship already awarded.
Applicant's hand signature:
Date:
(if sending the signature page by email, a scanned signature is accepted)
Please email before submission deadline to UICC APCASOT Program at apcasot@cancerqld.org.au
Privacy collection statement
APCASOT is a programme of the Union for International Cancer Control (UICC) and is administered by Cancer Council
Queensland (CCQ).
CCQ is collecting this information on behalf of the UICC in order to process your APCASOT application. In order to provide
you with the service(s) associated with the APCASOT program, it may be necessary to disclose your information to other
organisations such as the UICC, travel providers, external review committee members, etc. You may receive future
communications related to APCASOT, the UICC or CCQ activities and events that may be of interest.
Because our emails are stored in the cloud and some of our service providers are outside Australia, your personal
information may be transferred to our offshore IT service providers. However, we will take reasonable steps to ensure that
such information is stored securely and in accordance with the terms of CCQ’s Privacy Policy. Please refer to our Privacy
Policy for the list of countries in which your information may be stored or transferred. You consent to your information being
transferred or stored outside Australia for this purpose. You acknowledge that if such offshore entities handle your personal
information in breach of the Australian Privacy Principles they and we will not be accountable under the Privacy Act and
you will not be able seek redress under the Privacy Act.
CCQ’s Privacy Policy explains how you can access and correct any of your personal information and how to contact us if
you have any concerns. Your personal information will be handled by CCQ in accordance with the Privacy Act 1988 (Cth)
and it’s Privacy Policy (which is available at www.cancerqld.org.au or can be provided to you on request).
In completing and submitting this form, you acknowledge that you have read and agree to this privacy collection statement
and CCQ’s Privacy Policy.
You can contact us at publicofficer@cancerqld.org.au or Public Officer, Cancer Council Queensland, PO Box 201, Spring
Hill, QLD 4004.