2024 Oncology Conference Attendance Scholarship Application

Member Information

First Name: *

Last Name: *

Degree/Credentials *

AVAHO Member more than 1 year: *

Yes

Phone number *

Non VA Email Address: *

Place of Employment: *

Position/Job Title *

Street Address *

City *

State *

Zip Code *

Name of Conference Attending

Upload Conference Flyer *

Brief description why you are requesting conference attendance and how this will impact Veteran care *

Scholarship Commitment:

I understand by accepting this scholarship I agree to: *

Attend the conference which I am applying to attend

Provide interview and/or article with AVAHO highlighting knowledge gained for website use

I understand receipt of scholarship funding will be provided upon completion of AVAHO post conference Interview *

Yes, I agree to fulfill the terms of this scholarship

Signatuare *

clear

Date * +