Undergraduate Achievement Award application form

Please refer to the detailed information in the 'Undergraduate Achievement Award' page before you apply.

Before submission of this grant application please be sure to submit your abstract for the ESPE Annual Meeting 2021, via the abstract online submission portal. This is a requirement prior to completing the below form. You will be emailed a link to view your submitted abstract, which you must screen grab (print screen) and copy onto a document ready to submit where asked below as a PDF file.

To apply, please complete the form below and click submit. Any queries regarding filling the forms should be sent by email to the ESPE Office.

If your application is successfully selected, the applicant should confirm acceptance within 2 weeks of notification.

The form should be completed by the applicant.

For more information about how to write a good grant application, please click here.

17 May

APPLICATION DEADLINE

Undergraduate Achievement Award application form

Section 1: Candidate - Personal details

Annual Meeting you are intending to submit an abstract for *

Please state Annual meeting loction and year

Title *

First name *

Surname *

Nationality *

Date of Birth *

Other

Institution *

Personal phone number *

Personal email address *

Please provide ESPE membership number

Other societies you are a member of

Please list if multiple and include membership numbers

Section 2: ESPE sponsor

ESPE sponsor:

Your sponsor must be an ESPE current member who supports your application for this award. You must have their express consent before application as they will be copied into correspondence

Title/position held *

First name *

Surname *

Sponsor's institution *

Sponsor telephone *

Sponsor email *

Sponsor's current valid ESPE membership number *

Section 3: Abstract submitted to Annual Congress

Authors and affiliations *

Abstract *

Please upload a screen grab of the submitted abstract copied onto a PDF file. You will be sent a link to the abstract after submission to the abstract portal which you will be able to screen grab and copy.

Section 4: Consent and declarations

Consent for storing submitted data *

I confirm that all the information given on this form is my own and is correct *

Consent to share information *

I consent for my name and nationality to be promoted through ESPE channels regarding the reception of this award

File upload of scanned image of your signature *

Please scan your signature and paste to a Word document or PDF file and upload

Recaptcha *

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Undergraduate Achievement Award application form

Undergraduate Achievement Award application form

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