PCSI School - Advanced Design and Implementation of Case-Mix Funding Models
November 7 – 11, 2016
Nicosia, Cyprus

Hardship Fund Request Form

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

Title:    		
First Name:	     	
Surname:      	     	

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 100 words or less, explain why you are requesting financial assistance to attend the School.