PCSI School - “Design and Implementation of Activity Based Funding”
April 28 - May 2, 2014
Lisbon, Portugal

Hardship Fund Request Form

Once you have completed this application form please email it to school director Jeff Hatcher, at the following email address: jhatcher@cihi.ca

First Name:              Surname:              Title: 
Country of Residence:      
Email Address:      
Mailing Address:      
Daytime Telephone Number:       

Present Employment
Company/Organization:       
Position/title:      

The School tuition fee is 1700 euros.
Please indicate in the box to the right, the percentage of the fee that you are requesting to be subsidized by the PCSI Hardship Fund.	Requested Financial Assistance 	
	
      %

To be eligible for this financial assistance the applicant must be a full time student (proof is required), or from a ‘low income country’ as defined by the World Bank. In 200 words or less, explain why you are requesting financial assistance to attend the School.