World Stroke Congress Bursary Application

Please ensure that you have read and understood the criteria and objectives of this contest, as laid out in the CRSN Bursary to attend WSC page before submitting this application.

Fields marked * are mandatory.


Please answer the questions below in paragraph form, up to a maximum of 150 words per answer.
1. Why do you feel you should attend?*

Please list at least one reason

Briefly explain the benefits for you, your organization and/or your colleagues. Please limit your comments to a maximum of 150 words.

2. How will your share your knowledge?*

Please list at least one method of sharing

How do you plan to share your knowledge gained from this event? Please limit your comments to a maximum of 150 words.

Applicant's Full Name*

Please list your full name here

Legal name of applicant as you would have it appear on a check

Organization and Address applicant works for*

Please list the name and address of your organization

Name and full address of organization where applicant works

Applicant's Work Phone*

Please fill in your work phone number, including area code and any extension needed.

Usual daytime phone number, including any extension as necessary

Discipline or Position of Registrant*

Please make one choice from the list provided

Position within the Health Care System the registrant works for. Please be sure to CLICK on your selection

Applicant's Email Address*

Please supply your email address

Enter your primary email address

Confirm Email Address*

Please confirm your email address

Confirm your email address

WSC Registration Fee*

Total registration amount being requested

Any other comments

Anything else of relevance to this application?


Submission of Request
By clicking the box to the right, I agree to supply all original and final receipts for the funding being requested.
*
Invalid Input



This statement must be agreed to prior to submitting request


By clicking the box to the right, I acknowledge that I have read, understood, and agree to the criteria and objectives of this offer, as laid out in the CRSN World Stroke Congress Bursary page.

*
Invalid Input



This statement must be agreed to prior to submitting request


In the event this application is approved, you will be contacted to supply your SIN number and mailing address.
By clicking on the SUBMIT Application button, I acknowledge that the information I have provided is complete and accurate to the best off my knowledge.
World Stroke Congress Bursary Application

Please ensure that you have read and understood the criteria and objectives of this contest, as laid out in the CRSN Bursary to attend WSC page before submitting this application.

Fields marked * are mandatory.


Please answer the questions below in paragraph form, up to a maximum of 150 words per answer.
1. Why do you feel you should attend?*

Please list at least one reason

Briefly explain the benefits for you, your organization and/or your colleagues. Please limit your comments to a maximum of 150 words.

2. How will your share your knowledge?*

Please list at least one method of sharing

How do you plan to share your knowledge gained from this event? Please limit your comments to a maximum of 150 words.

Applicant's Full Name*

Please list your full name here

Legal name of applicant as you would have it appear on a check

Organization and Address applicant works for*

Please list the name and address of your organization

Name and full address of organization where applicant works

Applicant's Work Phone*

Please fill in your work phone number, including area code and any extension needed.

Usual daytime phone number, including any extension as necessary

Discipline or Position of Registrant*

Please make one choice from the list provided

Position within the Health Care System the registrant works for. Please be sure to CLICK on your selection

Applicant's Email Address*

Please supply your email address

Enter your primary email address

Confirm Email Address*

Please confirm your email address

Confirm your email address

WSC Registration Fee*

Total registration amount being requested

Any other comments

Anything else of relevance to this application?


Submission of Request
By clicking the box to the right, I agree to supply all original and final receipts for the funding being requested.
*
Invalid Input



This statement must be agreed to prior to submitting request


By clicking the box to the right, I acknowledge that I have read, understood, and agree to the criteria and objectives of this offer, as laid out in the CRSN World Stroke Congress Bursary page.

*
Invalid Input



This statement must be agreed to prior to submitting request


In the event this application is approved, you will be contacted to supply your SIN number and mailing address.
By clicking on the SUBMIT Application button, I acknowledge that the information I have provided is complete and accurate to the best off my knowledge.

Contact us

Champlain Regional Stroke Network The Ottawa Hospital - Civic Campus Civic Parkdale Clinic, Main North 1053 Carling Avenue Ottawa, ON K1Y 4E9

Phone: 613-798-5555 x 16153
SPC Phone: 613-798-5555 x 16156