Global Philanthropic Committee

Application for Funding Request

Funding is for educational purposes only. Deadline for submissions: August 15, 2016

All fields required, unless otherwise indicated.

Name of Organization *

Name of Project Coordinator *

Address

Street Address *

City *

State/Province (if applicable)

Postal code *

Country *

E-mail *

Contact Person (if not the same as above)

Name

E-mail

Country code *

Area code *

Phone # *

Extension

Are you a member of

AUA

EAU

ICS

SIU

Identify the educational goals and outcomes of your project *

Who will benefit from this project? *

How many participants are you expecting to reach? *

List in detail the specific needs of your project. This should include the resources required as well as their purpose *

Provide a detailed budget for your project by using the box below, or uploading a separate document *

Provide the timeline/date(s) for your project *

Provide the agenda/program that will be used during this educational project by using the box below, or uploading a separate document *

Please discuss how support for this project would lead to a sustainable and self-sufficient educational impact in the region *

Would you be willing to share your activity on e-Learning Portals *

If required, you may attach supplementary materials below

I agree, as Project Coordinator to prepare a report to be submitted to the Global Philanthropic Committee (GPC) within 4 weeks following the activity. This report will be used for internal purposes only. As a minimum, the report should include the following:

Project title
Location, venue and date(s)
Local organizing committee (if applicable)
AUA/EAU/ICS/SIU representatives (if applicable)
List of participants
Learning objectives
Scientific programme/agenda
Practical organization of the meeting
Results from participant evaluations

Global Philanthropic Committee

Application for Funding Request

Address

Contact Person (if not the same as above)

Are you a member of

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