1. Applicant Information Name * Home Address * Home Telephone * Email * Provincial Union * - Select -United Nurses of Alberta (UNA)Saskatchewan Union of Nurses (SUN)Manitoba Nurses Union (MNU)Ontario Nurses' Association (ONA)New Brunswick Nurses Union (NBNU)Nova Scotia Nurses' Union (NSNU)Prince Edward Island Nurses' Union (PEINU)Newfoundland & Labrador Nurses' Union (NLNU)Canadian Nurses Students Association (CNSA) 2. Project Description * In the space above, describe the purpose of the project, the coordinating organization, the duration of the trip, and overall cost to you the participant. 3. Describe what you hope to gain from this experiene * Travel dates * Year Year2011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 4. Accept conditionsBy providing your name and date below, you agree with the conditions of support, if approved. If your project is approved by the CFNU International Solidarity Fund Committee, we will ask that a short report (photos welcome) be filed within 60 days of your return with CFNU, describing your experience for CFNU use in promotion and reporting on the Fund, at which time approved funding will be disbursed. (Travel advances will be considered in exceptional circumstances). Signature * Please provide your first and last name as a signature.