Grant Application Form IOHA 2023 - International Oral History Association

Name *

First

Middle

Last

Phone number

(+Country code) Number

Email address

Leave an email address that you check frequently

Address – Street & building number

Street number, street name

Address – Unit number

Room, unit, or apartment number

Address – City area or district & city, town, or village

Local details for your address

Address – County, province, or state

Larger details for your address

Address – Nation or country name

Country wherein your address sits

Address – Postal code

Postcode, post code, PIN or ZIP Code

Are you presenting a paper, workshop or poster at the conference? *

Yes, I am presenting
No, I am not presenting

Title of presentation

If you are not presenting, you can leave this blank

Authors of presentation material

List any relevant authors. If you are not presenting, you can leave this blank.

Presentation abstract

Describe the presentation thesis, purpose, intent, or summary of content. If you are not presenting, you can leave this blank,

Personal statement

Why is it important for you to present at the conference? If you are not presenting, you can leave this blank.

Are you able to access another type of funding (part or whole) to assist with the costs to attend the conference? *

Yes, I have another source of funding
No, I do not have any other sources of funding

Current funding sources

List any additional sources of funding. If you have no other forms of funding, you can leave this blank.

Current funding amount

Value of funding available to you. Please use USD or EUR or list currency type. If you have no other forms of funding, you can leave this blank.

Current funding purposes

What is the purpose of these funding sources? If you have no other forms of funding, you can leave this blank.

Funding request – Accomodation *

Request amount for housing during conference. Please include currency (USD or EUR)

Funding request – Registration *

Request amount for event registration costs. Please include currency (USD or EUR)

Funding request – Travel *

Request amount for event travel costs. Please include currency (USD or EUR)

Funding request – Additional costs

Request amount for additional costs. Please specify those costs. Please include currency (USD or EUR)

Acknowldgements *

I may not receive reimbursement for all expenses, and I will be liable to cover any outstanding balance.
The grant is personal to me, and cannot be transferred to another person.

You must check both acknowledgements to be eligible for grant consideration.

Declarations *

I declare that I have read and understood the conditions of the 2023 IOHA grant.
I declare that the information I have given on this form is correct.

You must check both declarations to be eligible for grant consideration.