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International ALS MND Symposium Fellow Application 2022

Thank you for your interest in the annual Patient Fellows Program for the International ALS MND Symposium.

This program is led by volunteers who believe in not only the value that the Symposium provides to people with ALS but also the value that they provide back to the scientific discussions.

The program is coordinated administratively by I AM ALS.

Please review the Patient Fellows website at regarding the program, its purpose, and the selection process before filling out your application.

If you have questions or need more information, please use the Contact form at the Patient Fellows website

Please complete your survey in English.  The ALS MND Symposium is conducted in English.

Thank you very much.
This application is divided into five sections:
1. Your contact information
2. Your ALS MND
3. Your background in science
4. Your interests and why you should be a part of this program
5. Your agreement with the terms of the fellowship

To view a pdf to preview the entire application,  click here.

Part 1. Contact Information
1. The Patient Fellows Program reserves most of its 15 slots for people living with ALS; however, at least two of the fellowships are reserved for ALS MND caregivers and people with known ALS genes who have not been diagnosed with ALS MND.

I am a *This question is required.