Chemical Security Professional Development Grant Application

CHEMICAL SECURITY PROFESSIONAL DEVELOPMENT GRANT APPLICATION

Chemical Security Program (CSP)

Instructions:

Please follow the directions below to successfully submit your Chemical Security Professional Development Grant application to the U.S. Department of State Chemical Security Program (CSP):

1.  Fill out ALL fields of this form.

2.  Save the completed form to your computer.

3.  Prepare a scanned copy of your passport (passport page including picture).

4.  Prepare the most recent version of your Resume/CV.

5.  Submit the following to :

a.  Complete application form (Word document)

b.  Passport (including picture)

c.  CV/Resume

d.  Invitation letter or event announcement (if applicable)

Please note that the Chemical Security Program (CSP) cannot review incomplete applications.

Applicant Information
Title (i.e. Ms., Mrs., Mr., Dr.):
Last name: / First name: / Middle name:
Country of Citizenship:
Complete mailing address:
Mobile phone number:
Email address: / Alternate email address:

Highest degree earned:
/ Field of degree:

English fluency: (Please mark with X) ☐ Beginner ☐Advanced ☐ Fluent
Employment Information
Name of Current Organization, Institute or Agency:

Employer address:

Organization, Institute or Agency website URL (if available):
Office phone number (including country code): / Fax number (including country code):

Title and position:
Describe your position and job responsibilities:

What is your area of expertise?

Are you currently employed by a government agency? ☐Yes ☐ No
Did your Organization, Institute or Agency approve your travel? ☐ Yes ☐ No
If no, please explain:
Are you currently employed in the private sector? ☐ Yes ☐ No
If yes, what company?
Event information
Event name:

Event location:
Event description:
What is the start date for the event (DD/MM/YYYY)?

What is the end date of the event (DD/MM/YYYY)?

Name of event organizer: / What is the primary objective of the event?

Describe how your attendance at this event will contribute to improving chemical security in your current position:

Explain the relevance of this event to chemical security at your institution or in your country:

Describe your involvement in the event (oral presentation, poster presentation, collaboration on a project, etc.):

Will there be an examination or certificate of completion issued upon completion of the training course?
/ Do you have a letter of invitation to the event?
If so, please attach to your submission email.

Do you have any other sources of funding for this event?
/ Total estimated travel budget (including flight, hotel, per diem and ground transportation):

Event registration fees: / Visa fees:

How did you hear about CSP Chemical Security Professional Development Grants (i.e. email announcement, website, mailing list, colleague, etc.)? Please explain:

Application Submission
Upon email submission to , please attach the following:
1.  Complete application form (Word document)
2.  Scanned passport (including picture)
3.  CV/Resume
4.  Invitation letter or event announcement (if applicable)
Please note that the Chemical Security Program (CSP) cannot review incomplete applications.

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