Foundation Grant Application for AMIA 10x10 Course Beginning May 7, 2014

1. What is your name?
2. What is your Academy Member Number?
3. Have you registered for the 2014 AMIA/Academy 10x10 course?
4. If you answered "no", is it your firm intent to register by the deadline of May 7, 2014?
5. Please write a brief statement explaining your need for financial support.
6. Give two examples of what you would be willing to author in exchange for financial support for the 10x10 Informatics Education Program? (Examples: Nutrition Informatics blog posts; summarize your course experience for posting on, etc.)
7. Please tell how this course will enhance your current or a future position or role?
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