Scholarship application form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Are you an addiction or health professional from a low- and middle-income country (LMIC)?

Apply for one of the 4 scholarships to cover the registration fee, travel and accommodation expenses to attend our 2024 conference in Barcelona. The conference organisers will make the arrangements for the long-distance travel, accommodation and registration of awarded applicants (we cannot reimburse payments already made).

Before completing the application form, read carefully the instructions and requirements that you will find in the INEBRIA website: http://inebria.net/meetings-and-activities/conference/scholarships/

Email *

Name and Surname *

Telephone number *

(including international code)

Full Home Mailing Address *

(Street, number, city, post code and country)

Are you a member of Inebria? *

Remember that being a member is a condition sine qua non to be awarded with the scholarship. You canbecome a member by filling this on-line form: http://inebria.net/member-zone/home/signup/

Highest qualification or level of training
*

Years since obtaining highest qualification
*

Your Current Organization

(Full organisation name and acronym)

Country of your organization
*

Your position or job title *

Title (e.g., director, head of unit) or the position you occupy (e.g., PhD student, policy officer etc.)

FUNDING

Do you have any other funding/sources of support for attending INEBRIA conference? *

If yes, please give information of your other sources of funding

E.g., self-funded, national funding, other international funding + name of award and/or funding organisation

CONFERENCE ATTENDANCE & MOTIVATION

a) Have you attended any previous INEBRIA conferences? If yes, please give details. *

(Year/location.)

B)How will your attendance at INEBRIA benefit you?

(max 100 words)

c) How will your attendance benefit brief interventions for alcohol and/or other substances/risk factors for health in your local area/country? *

(max 100 words)

D) How will your attendance benefit INEBRIA? What will you bring to the conference or network?

(max 100 words)

e) Have you submitted an abstract for the conference? Please give title. *

Remember that submitting an abstract is a condition to be included in the selection process for a scholarship. You can find the abstract submission process here: https://inebria.net/barcelona2024/call-for-abstracts/

f) What kind of mentoring activities are you interested in? What areas of expertise would you likeyour mentor to have? *

Please give details (title, institution, year)

Do I hereby consent that the INEBRIA Secretariat hold by the Department of Health in Catalonia processes my personal data for the purposes of managing the institutional relationship of the INEBRIA Secretariat derived from the sending of information and publications, call for events and other activities, collaborations and presentations, subscriptions and any other types of communications derived from actions of INEBRIA? Consult our Data Protection and Privacy Policy for more details: http://inebria.net/about-us/privacy-policy/

Required

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms