The 11th Annual Workshop on - Harvard University
Harvard T.H. Chan School of Public Health
Office of Regulatory Affairs & Research Compliance
Ethical Issues in Global Health Research
September 23-26, 2019 - Boston, MA - USA
Scholarship Application Form
Scholarships are available to a limited number of workshop attendees. Scholarships include a waiver of tuition only. Scholarship recipients are required to pay any applicable travel and lodging expenses. Those interested in applying for a scholarship must submit this form with the required materials no later than July 19th, 2019. Any attendee who is awarded a scholarship will be notified in a timely manner and asked to register on-line via a scholarship registration link provided at the time.
Send to: Alyssa Speier
( Fax: 1-617-432-2165 ( Email: aspeier@hsph.harvard.edu
Please Print/Type Clearly
Gender : □ Male □ Female
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Name, Degree (s)
__________________________________________________________________________
Current Job Title
___________________________________________________________________________
Organization Name
___________________________________________________________________________
Mailing Address 1
__________________________________________________________________________
Mailing Address 2
_____________________________________________________________________________________________________
City State/Province Postal Code Country
Telephone: _____________________________________ Fax: _______________________________________
(Please Include Country/City Code)
Email Address: _________________________________________________________________________
Are you a first time attendee? □yes □no
APPLICATION REQUIREMENTS
Please include the following information with this form:
▪ Resume, Bio Sketch, or Curriculum Vitae (CV)
▪ Letter of support from your home institution/company/manager
▪ In a separate document, describe how you will benefit from attending this workshop and how it relates to your current job responsibilities.
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