HeFSSA Travel Scholarship Application Portal
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HeFSSA Travel Scholarship Information Pack
Applicant Information
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Title
First Name
Surname
E-mail Address
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example@example.com
Mobile Number
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Specialty
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Cardiologist
Paediatric Cardiologist
Cardio Thoracic Surgeon
Cardiac Physiologist
Electrophysiologist
Cardiology Fellow (Year 1)
Cardiology Fellow (Year 2)
Cardiology Fellow (Year 3)
Physician
Internal Medicine
Researcher (scientist in heart failure)
Other
Primary Hospital Affiliation
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Type N/A if not applicable.
Practice Sector
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Private Sector
Public Sector
Private & Public Sector
City
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Country
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Name, Date & Place of the Conference/Congress/Meeting
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Example: SA Heart Congress, 27 - 29 October 2024 in Sandton South Africa
Website Address for Conference/Congress/Meeting
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I am a paid-up HeFSSA member
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Yes
No
Is the congress/program/course CPD accredited?
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Yes
No
Do the academic program have a substantial focus on heart failure?
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Yes
No
I am involved in the congress as a:
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Delegate
Abstract or Case presenter
Faculty Member
Live Cases
Convener
Please give a short motivation at to why you have selected this specific program & why you would be a worthy recipient
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Support Sought for Registration Fee (in Rands)
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example: R4000 (indicate 0 if not applicable)
Support Sought for Accommodation (in Rands)
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example: R4000 (indicate 0 if not applicable)
Support Sought for Flights (in Rands)
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example: R4000 (indicate 0 if not applicable)
Support Sought for VISA-related Costs (in Rands)
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example: R4000 (indicate 0 if not applicable)
Total Rand Cost (Note: HeFSSA can award 2 travel grants annually to a maximum valued of R37,500 each)
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example: R4000
Total Rand Cost
Total Scholarship Amount Requested (Maximum R37,500)
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Upload Letter of Support from HOD (If still in full-time training)
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