Scholarship Application - Heineman-Robicsek Foundation

Purpose

The purpose of this scholarship is to facilitate the continuing education of a physician or advanced practice provider committed to advancing the knowledge in a specialty field. The award is to be used for tuition and travel to another institution for the purpose of learning a novel technique, adapting innovative technology and/or fostering collaboration in order to enhance patient care at the recipient’s home institution. The successful applicant will have a record of excellence in training and academic achievement. He/she will have secured a position at an institution capable of providing continued growth and development in the applicant’s specialty field.

Eligibility

U.S. and international physicians and advanced practice providers are eligible to apply.
Must be fluent in English.
Must meet all necessary prerequisites for travel to and from the training site such as visa, license, etc.

Funding

Awards of up to $25,000 will be granted and paid directly to the institution to cover the cost of tuition. Travel and other associated cost covered by the grant will be handled by Heineman-Robicsek Foundation.

Timeline

Applications Accepted: August 1st
Application Deadline: September 30^thNotification: December 1st

Applicant Information

Name (Last, First, Middle) *

Degree(s) *

Telephone Number *

Email Address *

Street Address, City, State, Postal Code, Country *

Applicant Institution

Institution Name *

Institution City/State/Country *

Department *

Your position at this institution *

Type of Scholarship

Is this for a fellowship?
YesNo

If yes, duration of fellowship

Name of institution offering fellowship

Is this for a study course?
YesNo

If yes, name and duration

Name of institution

Applicant Goals

Personal Goal Essay

Career Goal Essay

How the skills learned will be utilized at home institution

Mentor/Sponsor

Name (Last, First, Middle) *

Degree(s) *

Telephone Number *

Email Address *

Street Address, City, State, Postal Code, Country *

Budget

Total Funding Requested

Supporting Documents

Applicant CV and NIH Biosketch *

Mentor/Sponsor CV and NIH Biosketch *

Mentor/Sponsor Letter of Support *

Letter of Support from Head of Department *

Any additional letters of support (maximum 3)

Outline of Program Course (web link) *

Detailed Budget *

Medical Education Scholarship