Submission Process . Inspire Skin Confidence

Project title *

Project leader

Person in charge *

Doctor registration number

Hospital

Address *

Country *

Phone *

Email *

If the project is managed by an association/organization, please specify:

Name of the association/organization

Company registration number

Email

Phone

Address

Website

Aim of the association/organization

Activities of the association/organization

Overview of the project and your experience

What does the project consist of? What is the main goal?
In which of the three main fields that we have highlighted does your project fit under? (Tick all that apply)

Prevention and education on skin health: any initiative favoring the prevention of dermatological illnesses, and education for patients, their families and the general public (including support networks and campaigns) on dermatological pathology, dermatological conditions, impact awareness and promotion of good, healthy behavior
Examples include, but are not limited to: consultations/patient–family information workshops, school campaigns, information campaigns, advice on environmental factors and healthy living etc.
Improved quality of life and self-esteem for people facing skin issues: projects favoring improvements in quality of life for patients, whether this be physical or psychological.
Examples include but are not limited to: supporting and accompanying patients, help in accepting their condition(s), (psychological therapies) and reducing the stigma attached to their disease (e.g. make-up workshops, behavior therapy) etc...
Access to care, coverage and surgery: projects aimed at facilitating public and patient access to care.
Examples include, but are not limited to: free dermatology, free teledermatology, teleconsultations, telemonitoring, free mole-screening, free consultations, travelling doctors, nurse training, make-up workshops, free reconstructive surgery etc...

Please explain in what way your projects fit the areas you have ticked.

Describe, from your career path and your experience as a dermatologist, what led you to undertake this project ?

Describe in a few lines the context of your project:
State the problem that you would like to address:
Indicate the target population of your project:
What were your reasons for starting this project?
How could your project be defined as a responsible initiative?
How could your project be defined as innovative?
When did your project begin?

Competencies, skills, partners

What experience and skills were used to put this project into place and bring it into effect?

Who were the main partners (technical, financial, institutional, administrative etc.) involved in this project?

Project schedule

Describe in the following table the real actions put into place within the scope of this project, including frequency, the highlighted subjects, nature of participants, target population (type and number), supports used.

Summary table of main actions carried out within the scope of the project

1

Dates

Location : Premises, town

Supports and means used

Nature of action, subject, participants, target audience, population (number), directly or indirectly, affected by this project, etc.

Add new action

What are the next steps for your project? How would you develop the project further ? What do you want to develop if you win the prize ?

Patient benefit

Could you provide an estimate of the number of patients who have benefitted from your initiative since its launch ?

In your opinion, what were the benefits of this project for patients in terms of education, access to care, acceptance of their condition, well-being, self-esteem, adherence to treatment, and reduced stigma? Please highlight in particular the benefits for patients in terms of their social integration.

Publicity for your project

To evaluate the impact of your project, please include with your application any document produced by you or by a third-party organization concerning your project (press cuttings, photos, videos, internet site, pamphlet, brochure). By including content to your application you agree to refrain from violating other’s copyright or image rights or privacy rights.

Video

Upload a video

.mp4, .m4v, .mov or .avi (size limit 30MB)

File name:

File size:

Video Link

Upload additional content

.png, .jpg, .pdf or .doc (total size limit 10MB)

	Files
1	File name: File size:

Add new picture

Add links

	URL
1

Add new link

Terms of use *

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