CITAC/ACCFC Local Connections Fund - Event Application (2025-2026)
Thank you for your interest in applying to the Local Connections Fund. Please review the details below for your application.

EVENT APPLICATION INSTRUCTIONS:
- The event application is this Google form
- Application must be submitted by the program's iRep*
- iRep, please submit this application prior to your program's event (preferably 4 weeks in advance, ideally no later than 2 weeks in advance)
- CITAC/ACCFC Director of Finance will then review event eligibility and provide approval / request revisions within 2 weeks of submission
- Only approved events (submitted and approved prior to event) will be reimbursed, once appropriate documents have been submitted
- Please refer to the fund poster for more details (including eligibility and criteria)
- The current cycle is open for applications until August 31, 2026

*If you wish to co-coordinate an event and want to connect with your program's iRep, but you are not sure who they are, please contact the CITAC/ACCFC Director of Finance at finance@citac-accfc.org

WHAT TO COLLECT DURING EVENT:
- Tally the total number of physician-scientist trainee attendees (note that the event should be aimed toward physician-scientist trainees)
- Keep all original itemized receipt(s) associated with the event

WHAT TO SUBMIT FOR REIMBURSEMENT AFTER EVENT:
- Up to two weeks after event date, send an email to finance@citac-accfc.org including the following five items:
1) scan of original, itemized receipt(s)
2) actual number of physician-scientist trainees in attendance
3) brief feedback on how CITAC/ACCFC's presentation went during the event
4) email address to which CITAC/ACCFC should send the Interac e-Transfer for reimbursement
5) 3-4 sentence summary of the event (for CITAC/ACCFC to share publicly in a listserv / newsletter; photos are optional)

Thank you and please let us know if you have any questions or concerns.

All the best,
CITAC/ACCFC Director of Finance
finance@citac-accfc.org

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Email *
PROGRAM / IREP DETAILS
Program's university *
Name of iRep submitting application *
Please provide your first and last name.
Email address of iRep submitting application *
Email address to which CITAC/ACCFC will communicate approval / revision requests (it should match the email address listed at the top of the application form).
EVENT DETAILS
In this section, please provide the details of the proposed event. This information will be used to grant approval.

If you have any questions, please contact the CITAC/ACCFC Director of Finance at: finance@citac-accfc.org
Event date *
Please indicate the proposed event date and start time (should be at least 2 weeks from today).
MM
/
DD
/
YYYY
Time
:
Short event description *
Please describe the proposed event in 2-4 sentences.
Expected number of physician-scientist trainee attendees *
You will be required to provide CITAC/ACCFC with the number of attendees who actually attended retrospectively, so please take attendance during your event.
Budget overview *
Please provide a short budget overview for your event. We suggest submitting a simple breakdown that includes cost categories (e.g. food, venue) and total costs per category. Note that CITAC/ACCFC can cover alcohol costs. Please remember that CITAC/ACCFC will only reimburse the costs of an eligible event, up to $5 per physician-scientist trainee attendee.
Is your event exclusive to physician-scientist trainees? *
If your event is NOT exclusive to physician-scientist trainees, briefly describe how the event will be tailored toward physician-scientist trainees in your program *
Remember that only physician-scientist trainees who attend the event will be counted toward eligible funding amounts.
Describe how the event will enable a CITAC/ACCFC representative to speak / present a short slide-deck *
E.g. will the event have a projector, when in the event would be a good time for the CITAC/ACCFC representative to speak?
As the iRep, will you be the CITAC/ACCFC representative speaking at your program's event? *
If you are not the one who will speak, please write the name of the CITAC/ACCFC representative who will speak under "Other".
I understand that the event must be approved by the CITAC/ACCFC Director of Finance before the event date, and that I must submit an email (that includes the 5 items below) within two weeks after the event to be eligible for reimbursement. [Type your name below in lieu of a signature] *
The email should be sent to finance@citac-accfc.org and must include the following five items: 
1) scan of original, itemized receipt(s)  
2) actual number of physician-scientist trainees in attendance  
3) brief feedback on how CITAC/ACCFC's presentation went during event  
4) email address to which CITAC/ACCFC should send the Interac e-Transfer for reimbursement  
5) 3-4 sentence summary of the event (for CITAC/ACCFC to share publicly in a listserv / newsletter; photos are optional).
Do you have any other comments? (optional)
If your university was not listed above, or if you are not sure which CITAC/ACCFC representative will speak at your program's event, please elaborate here.
A copy of your responses will be emailed to the address you provided.
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