ࡱ> _a^a (bjbjjj (t?b?bjLbdddddd$!$E?@- bbЇ].N0,)%)%)%\?)%B F:  Harvard T.H. Chan School of Public Health Office of Regulatory Affairs & Research Compliance Ethical Issues in Global Health Research September 23-26, 2019 - Boston, MA - USA Scholarship Application Form Scholarships are available to a limited number of workshop attendees. Scholarships include a waiver of tuition only. Scholarship recipients are required to pay any applicable travel and lodging expenses. Those interested in applying for a scholarship must submit this form with the required materials no later than July 19th, 2019. Any attendee who is awarded a scholarship will be notified in a timely manner and asked to register on-line via a scholarship registration link provided at the time. Send to: Alyssa Speier ( Fax: 1-617-432-2165 ( Email:  HYPERLINK "mailto:aspeier@hsph.harvard.edu" aspeier@hsph.harvard.edu Please Print/Type Clearly Gender : % Male % Female ___________________________________________________________________________ Name, Degree (s) __________________________________________________________________________ Current Job Title ___________________________________________________________________________ Organization Name ___________________________________________________________________________ Mailing Address 1 __________________________________________________________________________ Mailing Address 2 _____________________________________________________________________________________________________ City State/Province Postal Code Country Telephone: _____________________________________ Fax: _______________________________________ (Please Include Country/City Code) Email Address: _________________________________________________________________________ Are you a first time attendee? %yes %no APPLICATION REQUIREMENTS Please include the following information with this form: Resume, Bio Sketch, or Curr,_`aswqYD4'ha5CJOJQJaJhughmO5CJOJQJaJ)hXG:5:B* CJ OJQJ^JaJ ph/h4hXG:5:B* CJ OJQJ^JaJ ph/h4hV25:B* CJ OJQJ^JaJ ph/h4hz5:B* CJ OJQJ^JaJ ph)hX}5:B* CJ OJQJ^JaJ phhX}hX}OJQJhX}OJQJhX}hX}CJ OJQJjh(ZUmHnHuhX}CJ OJQJ"jhX}OJQJUmHnHu -`a g h i gdz &d Pgdhgdy ^`gd WgdzagdKB.$a$gdKB. $Pa$gdX}$a$gdX}$a$gdKB.$a$gdX} $@&a$gd(Z $@&a$gdX}   & ' Ÿը~og_gTIA9hX}OJQJhaOJQJh_hZcOJQJh_h OJQJhdOJQJh4OJQJhhhoFFCJOJQJaJhXG:h 5:OJQJ^Jhu5:OJQJ^JhYF$5:OJQJ^Jh hKB.5CJOJQJaJhY5CJOJQJaJhXG:hKB.5CJOJQJaJhXG:hz5CJOJQJaJha5CJOJQJaJh>#o5CJOJQJaJ' 1 ; B C G H I J a e n     ĹumemZRFRhahaH*OJQJhaOJQJhmOhZcOJQJhdOJQJh4OJQJh_h4OJQJh_hZcOJQJh_OJQJh_h OJQJhzaOJQJhugOJQJh_h_OJQJh_hoFFOJQJhVhoFFOJQJhVhVOJQJhza5OJQJh#5OJQJh_h=M5OJQJhYOJQJ # $ k      1 I K L ƻշ{qjc[WPW[ hzahzahzajhzaU hXG:h W hXG:hs j:hXG:hs hXG:hyhX}hV hmOhmO hmOhh hmOh W hmOhs jhmOhs hXG:hYh WhXG:hXG:OJQJhugh CJOJQJaJhzaOJQJh6:OJQJhugOJQJhXG:hZcOJQJhmOOJQJL d e f g h i      & ( * | ٿ}l[}lJ}}6&hXG:hXG:5CJOJQJ\^JaJ h&SI5CJOJQJ\^JaJ h&SIh&SICJOJQJ^JaJ h&SIhtqCJOJQJ^JaJ&hXG:htq5CJOJQJ\^JaJ&hXG:h#5CJOJQJ\^JaJ2hXG:h1r5:B* CJOJQJ\^JaJph2h1rh1r5:B* CJOJQJ\^JaJphhXG:hyCJaJ hXG:hshVjhzaUhU,hza0Ji ( * | /0|Sgdh@&gdh  @&gdXG:@&gd#@&gd)}@&gdXG:gdz| ./{|6OQRSW`swسzizzXGXizXGzXz h&SI5CJOJQJ\^JaJ h45CJOJQJ\^JaJ hXG:hhCJOJQJ^JaJ&hXG:hh5CJOJQJ\^JaJ&hXG:hX}5CJOJQJ\^JaJ h#5CJOJQJ\^JaJ&hXG:hXG:5CJOJQJ\^JaJ hXG:h#CJOJQJ^JaJ&hXG:h#5CJOJQJ\^JaJ&hXG:hz5CJOJQJ\^JaJ02  "$ʸۤʐyhT=,hXG:hZcB*CJOJQJ\^JaJph&hXG:hZc5CJOJQJ\^JaJ hXG:hZcCJOJQJ^JaJ,hXG:hZcB*CJOJQJ\^JaJph&hXG:h1r5CJOJQJ\^JaJ&hXG:hh5CJOJQJ\^JaJ#hXG:hz6CJOJQJ^JaJ hXG:hzCJOJQJ^JaJ&hXG:hz5CJOJQJ\^JaJ h&SI5CJOJQJ\^JaJ "$VX(P(((@&]^gdY  & F@&]gdY  & F@&]gdoFF @&]gdoFF $d NgdZc @&]gd)}@&gdZc $VX(((F(N(f(i((((ϸwu]wH0H0/hYhoFF5B*CJOJQJ\^JaJph)hY5B*CJOJQJ\^JaJph/hXG:hZc5B*CJOJQJ\^JaJphU)hza5B*CJOJQJ\^JaJph/hXG:hoFF5B*CJOJQJ\^JaJph&hoFF5B*CJOJQJ^JaJph,hXG:hoFF5B*CJOJQJ^JaJph/hXG:hoFF5:B* CJOJQJ^JaJph/hXG:hoFF5:B* CJOJQJ^JaJphiculum Vitae (CV) Letter of support from your home institution/company/manager In a separate document, describe how you will benefit from attending this workshop and how it relates to your current job responsibilities. 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