IBEX - Application Form (151 KB, PDF)

Apply

Indigenous Biocultural Exchange Fund

Please complete all required fields, if possible please include information as shown on passport.

Section I - Applicant Information

Title

First/Given Name

Family/Surname

Date of Birth (mm/dd/yyyy)

Gender

Country of Citizenship

Passport Expiration Date (if applicable - mm/dd/yyyy)

Are you applying as an individual or organization?

First time traveling to a conference?

Name of indigenous or local community

Occupation/Job Title

Address Line 1

Address Line 2

City

State/Province

Country / Territory

Postal Code

Phone Number

E-mail Address

Confirm Email Address

Section II - Meeting/Event Details

Name of Meeting/Event

Meeting/Event website

City of Meeting/Event

Country of Meeting/Event

Meeting/Event Dates

Start Date of Meeting/Event

MonthDayYear

End Date of Meeting/Event

MonthDayYear

How Did You Hear About Us?

Answer the following (500 words minimum): Describe the proposed meeting/event you want to attend. Why is attending this event important? Why are travel, networking and exchange important for your local work? What proposed benefit will this meeting/event have on you, your organization and your community at large? What are your plans for sharing the information that you learn with your organization and your home community?

Section III - Estimated Budget (individual maximum of $5,000) (organization maximum will be considered based on application)

Will you be receiving funding by another organization?

Hotel/Lodging

Meals/Incidentals

Local transportation (travel to/from airport, taxi, etc.)

Conference Registration fees (if applicable)

Miscellaneous/Other

Visa fees (if applicable)

In this space please provide any explanation you wish for the above stated expenses

Section IV - Certification of Application

I hereby confirm that the information given above is true and correct. Please check here to confirm you agree with this statement.

Yes