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2018 IPOS Research Training Academy

Scholarship Application

Please type in ENGLISH.

Family name (as it appears on your passport): VOICU


First name: GABRIEL-Liviu
Profession: Physical Therapist+Emotional Freedom Technique (EFT tapping therapist)
Title:
Degree:
Work address:

Name of
Institution:
Department:
E-mail:
Passport
Number:
Passport
Expiry date:
Sex: MALE FEMALE
Date of birth:
Place of birth:
Country of
citizenship
Telephone
number:
Current full
home address:

All personal information provided is treated as confidential and will be shared only with the 
Scholarship selection committee and CRDF Global. Please note according to US grant regulations, 
awards must not be made to parties listed on the government wide exclusions in the System for Award
Management (SAM). Therefore, this system will be checked before issuing an award. Only your name,

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city, country, and place of work will appear in this Training Academy’s final report. Number and 
amount of scholarships will depend on funding.

Please answer the following questions:

YOUR WORK:

1. Please circle your level of psycho-oncology knowledge

BEGINNER INTERMEDIATE ADVANCED

2. Please circle your level of research knowledge

BEGINNER INTERMEDIATE ADVANCED

3. Have you ever conducted research in the past? YES NO


If so, please describe:
_______________________________________________________________________________
___________________________________________________________________

4. Do you currently conduct research? YES NO


If so, please describe:
_______________________________________________________________________________
___________________________________________________________________

5. Do you offer clinical psycho-oncology services to cancer patients? YES NO

(If NO, skip to Q. 9)

If YES - In your role as a psycho-oncologist providing clinical services to cancer patients:

6. Who are your patients (check all that apply):


____Adults ___Children ___Family members

7. How many cancer patients do you see in a year? _30

8. What types of cancer do you see in your patients?


_______________________________________________________________________________
___________________________________________________________________

9. What services do you provide to your patients? ____Physical Therapy

10. What types of consultation or teaching do you do with staff in your institution around psycho-
oncology issues?
_______________________________________________________________________________
___________________________________________________________________

11. Approximately how many students (medical/nursing/psychologist/social work) do you teach in one

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year? __20

12. How many psycho-oncologists are there at your hospital or institution in total? __5

13. What other disciplines (medicine, nursing, social work, psychology, psychiatry, occupational
therapists etc.) do you work with in providing psychosocial care?
____ Emotionally Focused Therapy (EFT)

14. Do you have an appointment at a university in your professional role? YES NO

15. If yes, are you on the Curriculum Committee at your university? YES NO

EDUCATION: Please list your educational experiences and degrees below starting with the most
recent:

Name of Major or Area of Degree Received Year Degree


University or Concentration Received
College
(example) Harvard Psychology B.A. 1990
University
Undergraduate
Education

Graduate
Education (list +Emotional
Master’s and Freedom
Ph.D. study on Technique (EFT
separate lines) tapping therapist)

16. If applicable, please list any extenuating circumstances (i.e., leave of absence from work for 
maternity/paternity, sickness, etc.) that explain a delay of more than 6 years since completion of 
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your training:

Extenuating circumstance Dates

17. If you have taken any post-college courses in Psycho-Oncology or related courses relevant to your
work in Psycho-Oncology, please list below:

Course Subject Where Taught Taught by Length of Course


Emotional Freedom Technique
(EFT tapping therapy)

18. What is your level of proficiency in English? BASIC - INTERMEDIATE - ADVANCED

19. Have you in the past received a scholarship to attend an IPOS Academy? YES NO

INTEREST IN ATTENDING THE IPOS 2018 RESEARCH TRAINING ACADEMY:

20. What motivates you to attend this Psycho­Oncology Research Training Academy? (no more than 

100 words)
__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________

21. How will you use this new research knowledge? (no more than 100 words)

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__________________________________________________________________________________

__________________________________________________________________________________

________________________________________________________________

22. Please describe a research project you would be interested in developing (no more than 100 

words):
__________________________________________________________________________________

__________________________________________________________________________________

________________________________________________________________

____________________________________________________________________________

23. Are you able to attend the entire 3 days Training Academy in Hong Kong (October 28-30)? YES

NO

24. Provided IPOS secures funds, are you able to attend the entire 3 days of the IPOS Congress in

Hong Kong (October 31-November 2)? YES NO

25. Are you a member of the International Psycho-Oncology Society (IPOS)? YES NO

26. Are you a member of your National Psycho-Oncology Society? YES NO

IPOS SCHOLARSHIPS FOR THE IPOS 2018 RESEARCH TRAINING ACADEMY:


Please provide a brief summary of how you hope to achieve the following:
27. Community Outreach: describe how you plan to develop your own country’s research programs
in psycho-oncology (no more than 100 words)
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

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____________________________________________________________________________________
__________________________________________

28. What elements of your research environment (research activity, resources and infrastructure ­ 

such as internet access, to databases, to scientific articles, to start­up funds ­ and mentorship) will 

contribute to the quality of your future research training experience?
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
________________________________________

29. Barriers: describe what you anticipate will be the main barriers to developing and implementing
your research project in your current setting, and your plan to overcome these barriers. (no more
than 100 words)
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
__________________________________________________________________

Note: Please note that travel arrangements and accommodations will be organized by IPOS for
recipients of the NCI Travel Scholarship. There will be no possibility of extending or altering these
plans.

Note: It is the responsibility of the applicant to ensure the application is complete. Incomplete
applications or handwritten applications will be automatically withdrawn from the contest without
notice. Applications will only be accepted if they are received at your earliest convenience before
June 22, 2018 to the following e-mail address: applications2018RTA@ipos-society.org. Applications
must include the fully completed Application Form, a five-page Curriculum Vitae for the applicant,
and a Copy of his/her Passport valid for travel to Hong Kong during the Academy.

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Note: Please send any questions you may have about this call for applications to the following e-
mail address: info2018RTA@ipos-society.org. IPOS will only be available to answer any questions
related to this call for applications from May 17, 2018 to June 7, 2018, after which IPOS will no
longer be able to answer. After June 7, 2018, the next correspondence the applicants will receive is
the result of the competition. Participants should anticipate receiving the results by the first week
of August. If you have not received a response, please check the IPOS website to know if there has
been a delay in the processing of the applications. If you have not received a letter of offer by the
first week of August, unless otherwise indicated on the IPOS website, it means that you were not
selected for the scholarship.

HOW TO SUBMIT THE APPLICATION?


Please email your Scholarship Application Form including the check list below, a current copy of
your Curriculum Vitae (CV) in English and a copy of your passport no later than June 22, 2018 to
the following email: applications2018RTA@ipos-society.org.
PLEASE NOTE THAT APPLICATIONS WITHOUT A 5-PAGE CV AND COPY OF PASSPORT WILL NOT BE
ACCEPTED.

Check list for the IPOS RTA application

Please confirm by checking the boxes that you meet the eligibility criteria below, and sign at the
end of this page.

I am a professional within completion of my academic training and establishment of my


independent career (i.e., within 6 years of completion of my academic training);
I am based in and conduct my research in LMIC in a clinical or academic field appropriate to the
field of psycho-oncology (e.g., physicians, nurses, psychologists, social workers, epidemiologist);
My country of residence is in Low-income and lower-middle income countries as defined by the
World Bank: https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-
country-and-lending-groups;
I am fluent in oral and written English;
I am providing a photocopy of a national passport from the country of residence valid for the
required period after departure from Hong Kong (November 3rd 2018) – Please check with your
appropriate embassy or consular authority to ensure your passport is valid for the required period;
I have no known criminal record;
If this is required (depends on the country of residence see link below), I commit to obtain a
Visit/Transit Visa from Hong Kong and show proof of this valid Visa to IPOS at least 2 months before
the RTA (before August 28th, 2018)
https://www.immd.gov.hk/eng/services/visas/visit-transit/visit-visa-entry-permit.html;
You can find the Visa form here: https://www.immd.gov.hk/pdforms/ID1003A.pdf
I am eligible to obtain a Visa from Hong Kong if a Visa is required:
https://www.immd.gov.hk/eng/services/visas/visit_transit.html;
I commit to attend the three-day Research Training Academy on October 28-30 if selected to
obtain a NCI Travel Scholarship;
Provided IPOS fundraising is successful, I commit to attend the three day IPOS Congress in Hong
Kong (on October 31-November 2) as well as specific events within this congress as mandated by
the RTA Organizing Committee: http://www.ipos2018.com/;
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I commit to developing a research project during the Research Training Academy and present it
briefly in a 15-min presentation on the last day of the Academy;
I commit to being mentored during 6 meetings over one year by an IPOS researcher for
continued scientific support in implementing a research project;
I understand that the Scholarships will comply with the Fly America Act, which will require that
all domestic and international travel funded be purchased from a US-flag air carrier. The Fly
America Act applies to any segment of a trip where a US-flag carrier is an available option;
I am opened to share a hotel room in double occupancy during the Research Training Academy
and Congress (with same sex pairing).

________________________________________________
Signature of applicant

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