PARO SEP Grant Application Form

PARO SEP Grant Application Please read the entire call carefully before completing the application form.

Every section of this application form must be completed in order to be valid. An application will only be considered if sections A, B, C have been completed, and the declarations signed.

Please submit the document to the link with the word by June 30th , 2020. When submitting your application, please rename the file to specify your name, member organisation and country Example: “Jean-Pierre Regalado - APEFYB, Peru” “Daniel Rivera - AGEQF-BO, El Salvador” SECTION A. Applicant Details Personal Details Full Name (Mr / Ms / Mrs) Date of Birth Full Address Country Telephone Number Email Passport and Visa Information Current Passport Number Valid until: Visa requirements SEP Details IPSF Member Organization OR Individual Member Number SEP Application Form ID Status of Application Length of Exchange Does not include personal travel arrangements before or after exchange, state the period of internship/placement only Previous SEP experience If yes, country: Study Details

Name of School of Pharmacy at which you are studying Address Email Degree to be received Total length of study Date of graduation (expected)

SECTION B. IPSF or students organization Involvement IPSF Involvement Briefly discuss your involvement within your national association and within IPSF (Max: 400 word

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SECCION E. Signatures APPLICANT Signature

Name Date Email