2015 AFD Junior Fellow Educational Fund Application
Please email the below application, CV, and the signed Memorandum to kristenzeligs@gmail.com
no later than 1 August 2015.
For questions 1-6, please circle, bold and underline the appropriate answer:
1. Member of AFD?
Yes
No
2. Current status:
PGY-1
PGY-2
PGY-3
PGY in civilian residency
PGY-4
PGY in military residency
JF in Fellowship Training
JF in Practice
3. Have you submitted an abstract to be considered for presentation at this year’s meeting?
No
Yes
If yes, what type of research:
Randomized Clinical/Scientific Trial
Case Report
Poster presentation
4. How many times have you previously been funded to attend AFD?
Never
Once
Twice
Three times
Four or more times
5. Are you a previous JF Education Fund winner?
Yes
No
6. Are you currently receiving funding from another source? If so, what is the source?
Yes
No
Source: ________________________________ Amount___________________
7. List all other meetings attended in the past 2 years.
8. Briefly describe your goals of attending the AFD meeting.