Scholarship Application
Please complete the following questions and submit your application to
kvandenbrook@aap.org by December 1, 2011.
Check box for scholarships you wish to be considered (Learn more about scholarships)
Resident/Fellowship Trainee Scholarship
Young Physician Scholarship
Applicant Information
Name:
Phone:
Email:
Member ID:
If resident/fellowship trainee, Residency/Fellowship Program:
If young physician, AAP Chapter:
I have cleared my calendar and if awarded this scholarship I will be able to attend the
conference.
Scholarship Questions (all applicants must complete these questions):
Describe your interest in advocacy? (250 words or less)
What advocacy training have you received through the National AAP or Chapter level?
(100 words or less)
Explain your commitment to parlaying what you learned at this conference into action
when you return home? (250 words or less)
How will you partner with your chapter and/or residency/fellowship program in these
efforts? (250 words or less)
In addition, we are requesting letters of support which will be due to
kvandenbrook@aap.org by December 14, 2011 to complete your application. Specifically:
 Residents/Fellowship Trainees please attach a letter of support from your Program
Director
 Young Physicians please attach a letter of support from your AAP Chapter
Please note: If chosen to receive a scholarship, you may be asked to write about your
experience for a newsletter article or a private online discussion forum. Also, based upon how
many applications received, the review committee reserves the right to ensure applicants are
chosen from a diverse geographic area.
* These scholarships are provided through the generous support of the
AAP Friends of Children Fund