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CRSN Application for Continuing Education Funds
A limited amount of funding may be available for continuing education financial support of Healthcare Professionals working with stroke survivors, for courses taken between April 1 and March 31 of each fiscal year.

In the event of over-subscription, priority will be given to those more directly involved in patient stroke care. Other considerations will include experience in stroke care, the relevance of the course content to regional areas of priority for improving stroke care, and the existence of a documented plan for dissemination of information.

Eligible expenses may include conference registration fees, travel and accommodation. ***Original itemized receipts*** must be supplied prior to financial support being paid. Applications without original receipts will not be processed until all requirements are completed. Note that these funds are intended for out of pocket expenses for individuals only, and are not intended for salary replacement or for institutional access.

Consideration will be given to applicants submitting requests by the deadline of midnight on January 15th and June 15th each year.

Due to the possible volume of applicants, only successful applicants will be notified, approximately two weeks after the application deadline.

Completion of this form does not guarantee that the applicant will receive funds, nor does it guaranteed that, if funded, all requested expenses will be covered. Funding will be at the discretion of the CRSN.

Fields marked * are mandatory.
Event Details
Please fill in details of event you are requesting financial support for. All amounts should be in Canadian currency,including all tax.
Itemized receipts will be required if request is approved.

Please supply the name of the program you attened

Fill in title of the event you are seeking financial support for

Please choose a date that the event occurred

Use date picker to choose date

Please choose a date that the event ended

Use date picker to choose date (leave blank if 1 day event)

Please enter a location here

Please say where the event took place. Please supply as much detail as is available

Please enter a description of the event or program

Please enter short description of the event. Include a web address to event web site if useful, or upload an electronic brochure (or scan) at the last page of this form.

You must select one of the two options

Is this for an event you have already attended or are planning to attend in the near future?


Event Evaluation
Provide brief comments on the value of the event, to help evaluate application.

Please list at least one benifit

Briefly explain the benefits for you, your organization and/or your colleagues. Please limit your comments to a maximum of 100 words.

Please list at least one outcome

Describe how this educational event advances and supports clinicians with integrating stroke best practices. Please limit your comments to a maximum of 100 words.

3. Name three ways that the knowledge gained from this event may be shared, both in your practice setting and in the region. In-service? Teleconference? Video-Conference? Written Summary? Provide a few details.
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Please supply up to three ideas the knowledge could be shared

Expenses Being Applied For
(leave any non-applicable fields blank)

Please report all expenses in Canadian currency, and all expenses must comply with the CRSN expense guidelines (Lowest possible air or train fares, reasonable hotel rates up to a maximum of $200 per night, and so on). Itemized receipts will be required for all expenses claimed (not just credit card receipts).

Please supply the amount of the program you attended in Canadian currency

Supply cost of program attended; Numbers only please, no $ or explanation

Please use numbers only in this field

Total of KM travelled, based upon distance from the CRSN Hospital nearest your home to the event destination; Numbers only please, no "km" or explanation

Total car amount being requested (at rate of 45¢ per km)

Please use numbers only for this field

Total cost of air or train ticket; Numbers only please, no $ or explanation

Please use numbers only in this field

Total Hotel costs; Numbers only please, no $ or explanation

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Number of nights requested for hotel room coverage

Please use numbers only in this field

Total Meal costs, if appropriate
($10 breakfast, $15 lunch, $25 dinner, no alcohol for any meal). Numbers only please, no $ or explanation

Please use numbers only in this field

Provide cost and short description of other relevant expenses. Numbers only please, no $ or explanation

This is a calculated field

Here is the total amount your are requesting in this application

Please use this field to give any explanations for expenses you may find necessary.


Financial application

You must select either "Yes" or "No"

Have you applied to any other funding body for funding for this event?

Fill in details of other funding applications for this event

You must select either "Yes" or "No"

Have you applied for funding with the Regional Stroke Program before?

Fill in details of previous applications to the regional Stroke Program for this or other events

Identification information.
To complete this application, please include all information that is relevant to your request.

Please supply the registrant's First name

First name of applicant

Please supply the registrant's Last Name

Last name of applicant

Please supply your email address

Enter your primary email address

Please confirm your email address

Confirm your email address

Please fill in your work phone number, including area code. Please use only numerals, not "-" or".",
Do not use any characters like "X" or "x"

Usual daytime phone number. Please list extension in the next field. Please enter numbers only, no letters, spaces, dashes or symbols

Enter the number of your extension, numerals only please, no symbols or special charcters

Phone Extension if needed

Please list the name and address of your organization

Name and full address of organization where applicant works

Please choose your best estimate of the average number of clients you see, or N/A

Average number Stroke clients you see in a week, or "N/A"

Please make one choice from the list provided

Position within the Health Care System the registrant works for. Please be sure to CLICK on your selection

Please add a value for First Name of Manager or Scheduler.

Applicant's Manager's First Name

Please add a value for the Last Name of your Manager or Scheduler.

Applicant's Manager's Last Name

Please supply your manager's email address

Manager's email

Please fill in your work phone number, including area code. Please use only numerals, not "-" or".",
Do not use any characters like "X" or "x"

Manager's usual daytime phone number. Please list extension in the next field. Please enter numbers only, no letters, spaces, dashes or symbols

Enter the number of your extension, numerals only please, no symbols or special charcters

Phone Extension if needed

Anything else of relevance to this application?

Submission of Request
In the event this application is approved, the following information will be required for accounting purposes. You will be contacted to supply your SIN number at the time the payment is made.
Invalid Input

Please list full name of recipient, or Institution the cheque should be made out to

Invalid Input

Please supply the full mailing address that any cheque issued should be sent to.

Upload a reasonably sized event brochure or other documents in PDF, image file, or similar format to support your application. Please ensure it is no larger than 2mb.


I agree to supply all original and final receipts for the funding being requested. I acknowledge that any final payment will not be processed until such time as these receipts are supplied.
Invalid Input

This statement must be agreed to prior to submitting request



By clicking on the submit button below, I acknowledge that the information I have provided is complete and accurate to the best off my knowledge.

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