Agriterra Grant Application Form

Thanks to our main sponsor Agriterra, a (limited) number of grants will be available to presenters of accepted papers. Priority will be given to applications from PhD students and junior scholars from the Global South.

Request will be dealt with in order of date of submission, therefore we advise you to file your request as soon as possible, especially in case you need a visa for your visit to the Netherlands: Dutch embassies will start to accept visa requests for July 2017 from April 2017 onward.

You will receive notification about our decision on your request as soon as possible after you have submitted the form underneath. Due to the number of requests and the size of the conference, decisions by the conference organizers on grant requests are not open to appeal or discussion.

For your grant request, please fill out and submit the grant application form underneath.

Agriterra Grant application form

Gender (as mentioned in your passport) *
MaleFemaleTransgender
First name *
Last name *
Date of Birth *dd/mm/yyyy
Place of Birth (including Country) *
Nationality *
Email *
Home address *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Organization *
Department
Current position *
Current country you work in *
ID of paper presentation *Please provide the ID of your abstract (preferred) or, in case you do not recall the number of your abstract, the title of the accepted paper you will present at the conference.
Have you applied for a grant for this conference with your organization / funding agencies in your country? *
yesno
In case you did not apply elsewhere for grants, please summarize reasons for not applying
In case you want to upload any documents (support letters form your organization, denied requests with other funders, etc.), you can upload them here
Travel dates Underneath, you can enter your scheduled date of arrival in the Netherlands and date of departure from the Netherlands.

Please notice:
* if you want to attend a pre-conference workshop, arrival should be ultimately on July 8
* if you want to attend the opening ceremony, arrival should be ultimately on July 9.
* we expect grantees to attend the whole conference; please schedule your return flight on July 15 or 16, 2017.
Expected date of arrival *dd/mm/yy;
Expected date of departure *dd/mm/yy
Will you require visa? *
Please make sure that you apply for visa with the proper Dutch embassy well in time; Dutch embassies will however only accept applications within 3 months in advance, i.e. from April 2017 onwards. See also https://www.government.nl/topics/visa-for-the-netherlands-and-the-caribbean-parts-of-the-kingdomyesno
Embassy contact details
Please enter the contact details of the embassy where you need to apply for visa. See also https://www.government.nl/topics/visa-for-the-netherlands-and-the-caribbean-parts-of-the-kingdom
Airport you will travel from and back to
Requested grant items * Please indicate the items you apply a grant for.
* Please do notice that reimbursement of travel costs, if granted, will only be on reimbursement basis after the conference on submission of the original travel tickets and boarding passes to the Conference Secretariat and therefore needs to be pre-financed by yourself.
*
Conference fee waiverTravel costs
Please provide us with an estimate of your travel costs, in USD. For indications, you can use (for instance) www.wtc.nl. Use Amsterdam Schiphol Airport as destination for any estimates.
Please provide us with a print of the travel costs estimate.
Declaration * I declare to have provided all the data in this form truthfully.
* I declare to be aware of the fact that, in case reimbursement of travel costs will be granted, reimbursement will only take place after the conference on the basis of the original travel tickets to and from the conference location and that I will be required to send these original documents to the Conference Secretariat within 2 weeks after the end of the conference.
* I declare to be solely responsible for arranging proper health insurance, travel insurance, as well as the proper travel documents, such as visa, well in time and that lack of any of such insurances and/or proper travel documents may result in cancellation of any grant.
*
I agree
Authorization I hereby authorize the conference organizers to inform the Dutch embassy and/or the proper authorities (or any other office fulfilling the embassy's formal tasks) about my participation in the IASC2017 Conference, about any grants eventually granted to me, and to provide the embassy / authorities / office involved with my personal details, for as far as these will be required to apply for visa or any other required travel or official documents.
*
I agree
Additional remarks

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