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IPAC Canada

IPAC Southwestern Ontario

IPAC-SWO IPAC Education and CIC/LTC-CIP Funding

Before submitting an application, review the IPAC-SWO Educational Funding terms and conditions and submission instructions. All sections of the application must be completed. Where there is no information to be provided, state "Not Applicable"

Applicant Information
IPAC SWO Chapter Member (confirmation of membership will be validated with current IPAC SWO member list)*

Application for Award
Which award are you applying for?
If you chose IPAC Course
Select IPAC Canada sponsored, acknowledged or endorsed course that was successfully completed

If you chose CIC/LTC-CIP Initial Certification

If you Chose CIC Recertification

I confirm that I have not received funding from other sources for this educational course/CIC/LTC-CIP certification or recertification (e.g. employer, IPAC Canada CIC certification award, other IPAC chapter)
I confirm that, if chosen for this award, I will immediately notify my employer and will not apply or accept additional reimbursement of certification examination expenses (e.g. IPAC Canada CIC Award)

I attest that I have been truthful in all responses to questions contained in this application.
I give permission for IPAC SWO to publish my name and photograph on the IPAC SWO Chapter website or on Chapter communications/reports

Proof of successful course completion/CIC/LTC-CIP certification or recertification and receipt for course/certification fees is required to be submitted with this application to be considered for an award.  

Validation Code