Application - Hematology Workforce Training Program

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APPLICATION FOR HEMATOLOGY WORKFORCE TRAINING PROGRAM
Integrated Training in Development and Clinical Practice of Cell Based Therapies
Allison Hubel, PhD, David McKenna, MD, Program Directors
University of Minnesota, Minneapolis, MN
PLEASE TYPE OR PRINT
Name___________________________________________________________________________________________
(Last)
(First)
(Middle)
Present
address_________________________________________________________________________________________
_________________________________________________________________________________________
Email: _____________________________________________________
Telephone (work) ___________________________
(home)________________________________
Are you a U.S. Citizen or have been granted permanent U.S. Residency?
Yes
No
Available training dates_______________________________________________________________
Will you need assistance obtaining lodging during the training?
Yes
No
INDICATE MODULES OF INTEREST
□ Manufacturing of Clinical Cell Therapies
□ Preservation of Cells
□ Hematopoietic Stem Cells
□ Immunotherapy
□ Transfusion Medicine
□ Blood and Marrow-Derived Stem
Cells for Non-Hematological
Diseases
In the space below, please describe your personal goals (why is this program of interest to you).
This information will help tailor the training to your interests.
Attach your CV/resume to application and email to [email protected]
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