HBIC Award Application Form

L’organisation de cette initiative se déroule uniquement en anglais.

BEFORE COMPLETING THIS FORM

We kindly ask that you review the application instructions before completing this form. For reasons of privacy, this form does not offer a "Save and Continue" feature as this involves storing personal information on our servers without your express consent.

IMPORTANT: We recommend that you review the form and prepare the elements of your submission in advance, and then return to complete the form once all your elements are ready.

If you have comments or other questions concerning this application, please contact the HBIC Award Team at H.B.InternationalAward@gmail.com.
For technical assistance, please contact the IBTN web team at help@ibtnetwork.org.

Applicant Information

Full Name * Requis
Prénom Nom
Title * Requis
Please indicate your title (e.g. Dr., Mr., Mrs., Ms.).
Gender * Requis
Please indicate your gender
- Woman
- Man
- Non-binary / Gender diverse
- My gender identity is not listed
- Prefer not to say
Gender identity * Requis
Please indicate the gender you identify with.
Home Country * Requis
Please indicate your home country

Pays
Home Institution * Requis
Please indicate the main institution at which you are currently employed or studying.
Position * Requis
Please indicate your current position at your home institution.
Date of conferral of terminal degree * Requis
Please indicate the date on which you received your most recent degree.
IMPORTANT NOTE ABOUT CONFERRAL DATE
Conferral must be within 5 years from application closing date, i.e., May 2, 2016, excluding career interruptions such as parental leave/extended medical leave, or part time status due to family commitments/career responsibilities.

Please provide description of career interruptions, if required (maximum 1000 characters):
Email * Requis
Please indicate your email address for the purposes of this application process.
Enter your email address Re-enter your email address
Location * Requis
Please indicate your current location.

Ville État / Province / Région Pays
Applicant's Organisation Affiliation * Requis
Please indicate the sponsoring organization you are affiliated with.

Mentor Information

International Mentor's Full Name * Requis
Prénom Nom
International Mentor's Title * Requis
Please indicate the international mentor's title (e.g. Dr., Mr., Mrs., Ms.).
International Mentor's Home Country * Requis
Please indicate the international mentor's home country

Pays
International Mentor's Home Institution * Requis
Please indicate the international mentor's home institution.
International Mentor's Position * Requis
Please indicate the international mentor's position at the home institution noted above.
International Mentor's Organisation Affiliation * Requis
Please indicate the sponsoring organization the international mentor is affiliated with.

Note: This does not have to be the same organization that you are affiliated with.

Project Information

Organization to which you are applying to fund your award. * Requis
Please indicate the organization(s) to which you are applying to fund your award.

Note: You may select more than one option but winners are not eligible to receive more than one award. You will be considered for all awards for which you are eligible.
- American Psychosomatic Society
- German Society of Behavioral Medicine and Behavior Modification
- International Behavioural Trials Network
- International Society of Behavioral Medicine
- Society for Health Psychology
- Society of Behavioral Medicine (USA)
Proposed Project Collaboration Dates * Requis
Please indicate the proposed range of dates for the collaboration.
Project title * Requis
Please enter your project's title (100 characters maximum)

Project Application Documents

In this next section, you are asked to upload the six (6) required application documents:
- 1. Applicant's Letter of Intent
- 2. Applicant's CV
- 3. Institution's Letter of Support
- 4. International Mentor's CV
- 5. International Mentor's Confirmation Letter
- 6. Evidence of membership

1. Upload your Letter of Intent * Requis
Maximum two (2) pages. Please refer to the Application Instructions for complete instructions about the Letter of Intent.
Types de fichiers acceptés : doc, docx, odt, ott, pdf, rtf.
2. Upload your CV * Requis
Provide your most current CV (maximum 4 pages). Please refer to the Application Instructions for complete instructions about the CV.
Types de fichiers acceptés : doc, docx, odt, ott, pdf, rtf.
3. Upload Institution's Letter of Support * Requis
Provide the Institution's Letter of Support (maximum 1 page) Please refer to the Application Instructions for complete instructions about the Letter of Support.
Types de fichiers acceptés : jpg, pdf, png, doc, docx, odt, ott, rtf.
4. Upload International Mentor's CV * Requis
Provide the international mentor's CV (maximum 4 pages). Please refer to the Application Instructions for complete instructions about the international mentor CV.
Types de fichiers acceptés : doc, docx, odt, ott, pdf, rtf.
5. Upload International Mentor's Confirmation Letter * Requis
Provide the international mentor's Confirmation Letter (maximum 1 page). Please refer to the Application Instructions for complete instructions about the Mentor's Confirmation Letter.
Types de fichiers acceptés : jpg, pdf, png, doc, docx, odt, ott, rtf.
6. Upload Evidence of membership (if applicable)
Provide evidence of your affiliation to the organization you indicated earlier (payment receipt, email confirmation of membership, etc.).

Note: If you have selected more than one sponsoring organisation, please combine any relevant evidence documentation into a single file for upload.
Types de fichiers acceptés : jpg, pdf, png, doc, docx, odt, ott, rtf.
Additional Information (optional)
If you feel additional information could be relevant to your application, please include it here (maximum of 250 characters).
Applicant Statement of Consent * Requis
By submitting your application, you hereby consent to sharing the information contained in your submission with the HBIC for purposes of this grant competition. You also attest that the information provided in your application is both complete and accurate.
- I consent to sharing the information in my submission with the HBIC.
- I attest that the information provided in my application is both complete and accurate.
Consent to Share * Requis
I consent to the virtual collaborative activities included in this application being shared as part of the "Frequently Asked Questions" section of the HBIC application instructions for future award rounds. PLEASE NOTE: Your choice will not impact the assessment of your application in any way.
- I consent to parts of my submission being shared in the FAQ section of the HBIC webpage during future rounds of the competition.
- I DO NOT CONSENT to parts of my submission being shared in the FAQ section of the HBIC webpage during future rounds of the competition.
Please review all fields before clicking the submission button below.
After submitting your application, please wait for the confirmation message to be displayed on screen before closing this window.

An email confirmation will then be sent to the email address you indicated in your submission. Please save this message for your records. If you do not receive an email confirmation after submitting your application, please check your spam and/or junk mail. If no confirmation email is received, please contact help@ibtnetwork.org without delay for assistance.

Please review all fields before clicking the submission button below.