The Warfield Scholarship for Anesthesia Professionals

Please note: candidates must have an identified training opportunity in order to apply.
Candidates may include physician and non-physician anesthetists affiliated with HVO project sites.

TELL US ABOUT YOUQuestions marked with an * are required.

Given Names of Applicant *This question is required. (as appear 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)?

Please indicate your professional associations:

Please use the full name, not acronym, of the organization.

LETTERS OF SUPPORT *This question is required.Please include two letters of support: one from the head of the department or school and another from a supervisor, teacher or HVO volunteer who can attest to your academic and professional abilities and potential.

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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. This question requires a valid date format of MM/DD/YYYY.

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Please briefly explain the professional opportunity you would like us to fund. *This question is required.

Please explain why you want to participate with this opportunity and how it will impact your career in anesthesia. *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 Warfield Scholar, I will be part of a cohort that is surveyed annually to gather ongoing data on my career and professional development.