Application Form 1
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PERSONAL DETAILS
Name
Surname
Email (Academic or Work)
Phone number
Institution
PUBLICATION
Title of the Article
Journal Name
Journal Impact Factor
Date of Acceptance
DOI (If Available)
FINANCIAL INFORMATION
Total Publication Fee (€)
Amount Requested (max €2,000) Has any part of the publication fee been covered by other funds? YesNo If yes, please provide details
Proof of article acceptance 8MB Max
Publisher's Invoice or quotation 8MB Max
Journal metrics confirming IF > 2 (Screenshot) 8MB Max
Declaration I hereby declare that the information provided above is accurate and that the publication has not received funding for open access fees from any other source. I understand that if the application is successful, I am encouraged to acknowledge CRIHM's support in the publication and consent to having the publication listed on the CRIHM website.
Send me an email receipt of my responses
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