HVO Orthopaedic Scholarship Application

Please note: candidates must have an identified training opportunity in order to apply.
Candidates may include local residents, faculty and clinicians at HVO project sites.

Questions marked with an * are required.

Given Name of Applicant *This question is required. (as it appears on Passport)

Surname (as it appears on Passport)

Applicant Email *This question is required. This question requires a valid email address.

Employing and/or Educational Institute *This question is required.

Please upload your Curriculum Vitae (CV) *This question is required.

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Do you belong to any professional association(s)? *This question is required.

Please indicate your professional associations: Please use the full name of the organization.

Letter of Support *This question is required.Please include a letter of support from an HVO project director or volunteer.

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Letter of Support *This question is required.Please include a letter of support from your employing or educational institute and/or from the appropriate professional association.

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Letter of Support *This question is required.Please include a letter of support from your employing or educational institute and/or from the appropriate professional association.

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ABOUT YOUR PROFESSIONAL OPPORTUNITY
Candidates must have an identified training opportunity in order to apply.

Start Date of Professional Opportunity *This question is required. Please note: Applications must be received at least 4 months prior to the event that requires funding This question requires a valid date format of MM/DD/YYYY.

calendar

Please briefly explain the professional opportunity you would like us to fund. *This question is required. If the request is for a conference, please include a link to the relevant website about the conference.

Please explain why you want to participate with this opportunity and how it will impact your professional development and/or leadership potential. *This question is required.

Please tell us how you will share the information you will learn from the opportunity with your colleagues and other health workers at your institution. What is your plan of action? *This question is required.

BUDGET

How much money (in U.S. dollars) are you requesting? *This question is required. This question requires a valid currency format.

Total Budget

What is your plan for these funds? How much will you spend on the following: *This question is required. This question requires a valid currency format.

Travel
Registration Fees
Food & Lodging
Education Material
Other

Please describe any "other" expenses.

Please acknowledge the following statements by marking the check-box. *This question is required.

I understand that I will be required to submit a report (no longer than 5 pages) within 30 days of completion of project outlining the experience and lessons learned. I also understand that if selected as a Scholar, I will be part of a cohort that is surveyed annually to gather ongoing data on my career and professional development.