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1. First Name (as on your passport)

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2. Middle name (as on your passport)

3. Last name (as on your passport)

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4. Nationality

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5. Passport country of issuance

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6. Passport number

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7. Date of birth (dd/mm/yyyy)

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8. Passport issue date (dd/mm/yyyy)

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9. Passport expiry date (must be min. end of January 2024; dd/mm/yyy)

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10. Travel method: The grand majority of all travel to Rwanda will be via plane. If you are already in Rwanda, you will likely take a different method of travel depending on the distance from Kigali. - Do you need transportation to the conference?

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11. Transportation information: For this conference, Women Deliver’s Professional Conference Organizer will book you to and from Kigali, Rwanda. The Expected Travel Dates are July 15th – July 21st. This allows you to attend the conference and all relevant pre-conferences. If you would prefer to depart at a later date, please explain which dates and for which purpose. Please note that your scholarship does not cover extended dates. If you decide to extend your travel, you would be responsible for all additional expenses including accommodation, food, transportation etc. The flight cost will still be covered, as long as it does not exceed the original price.

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12. If you have different dates for departure from Kigali, please explain

13. Preferred date of departure from Kigali, Rwanda

14. Preferred airport of departure to go to the Conference

15. Preferred airport destination from Kigali

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16. Food restrictions or allergies (for inflight meals)

17. What is your scholarship type?

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18. Please indicate which media outlet(s) or social media channels from which you will cover the Conference.

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19. Please indicate your primary gender equality issue areas of interest. 

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20. Areas of interes - Other, please specify

21. Will you attend a pre-conference? 

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22. Do you need a Visa to enter Rwanda? 

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23. Per diem payment options: As a scholarship recipient you will receive the following: 1. The equivalent of $50 US per diem (per day) to cover meals and incidentals, based on the number of nights stayed at the Women Deliver-sponsored hotel. 2. A fixed amount stipend for travel expenses to and from your home airport, and the costs associated with obtaining a travel visa, should a visa be required. In the field below, please indicate how you would prefer to receive it. - How would you prefer to receive this payment?

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24. If you chose bank transfer, please share the details requested. - Account name

25. Account type

26. Account number

27. IBAN

28. Bank Swift Code

29. Bank ABA/routing number

30. Account currency

31. Bank name

32. bank beneficiary (as it appears on bank account)

33. Bank Address (Street incl number)

34. State, Province, Region

35. Country 

36. Postal Code

37. Intermediary Bank - Bank name

38. Intermediary Bank - Account name

39. Intermediary Bank - Routing number

40. Intermediary bank - Account number

41. If you chose PayPal, please share the requested details below. - PayPal Account email

42. PayPal Account name

43. Country associated with your PayPal Account.

44. Is my account properly set up to receive payments in US dollars from a US financial institution? If no, please ensure that your preferred account can receive US dollars from the US before you submit the form, to avoid any delays. 

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