Section 1 - Applicant Information

1. CIHR Personal Identification Number (PIN)
   Enter your CIHR PIN. If you do not have one, visit the new user registration page to register for a PIN and password
2. Name of applicant
   Provide your family name and given name
3. Affiliation
   Indicate the name of your host research institution
4. Institution paid
   Only applicable to postdoctoral fellows
5. Address
   Indicate your residential address
6. Telephone number
   Indicate your residential telephone
7. Email
   Provide your Email address

Section 2 - Request for Funding Information

1. Project title
   Provide your abstract title
2. Are you applying as an...
   Select as an "individual"
3. If you are requesting funds from other CIHR Institutes please indicate them
   Not applicable
4. If you are requesting funds from other sources then CIHR please indicate them
   Indicate if you have or will request for other travel funds from sources other then CIHR; if yes, please specify the sources
5. Total amount requested
   Maximum amount that can be requested is $1,000
6. Start date of funding request: month/day/year
   Specify the date of the conference
7. Duration of funding request (in months)
   Not applicable
8. Using the following model, please submit, as an attachment to this application, a budget table that includes names of all funding sources, amounts and timelines requested for his activity
   Not applicable
9. Provide a justification for the amount and duration of the funding request
   Include a proposed travel itinerary and detailed budget of your expenses

Section 3 - Activity Description

1. Provide the rational and objective(s) of the funding request
   Not applicable
2. How does this request align with the Instiute's mandate?
   Provide a summary of your present research and its relevance to ICRH's mandate
3. Provide a description of the activities for which support is being requested
   State the title and relevance of the meeting to the mandate of ICRH
4. Provide the anticipated outcomes of the funding request
   Demonstrate how attending the selected meeting will benefit your career
5. Provide information on the anticipate size of the target audience and the specific intended use of the CIHR grant or award
   Not applicable
6. Describe the need for this activity, including a statement why this request cannot be funded under existing CIHR funding programs
   Not applicable

Section 4 - Signature

Mandatory

You must send the following formats of the ISC form to the Institute:

• Complete and sign the ICS form, then fax it to CIHR at: 613-954-1800 Attention: Jennifer Ralph (ICRH)
• Send an electronic copy of the ICS form and the appropriate supporting documents to the Institute by email at: jennifer.ralph@cihr-irsc.gc.ca