Walter P. de Groot Scholarship Application

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* 1. Applicant's Information:

Full Name

Organization

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 2. Will you be submitting an abstract to the 2021 AVLS Annual Congress?

No

Yes (Please include the title of your abstract submission)

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* 3. Please, upload your letter that answers the following:

What specific area of interest within venous and lymphatic medicine are you passionate about and why?

Why do you want to attend the AVLS Annual Congress, and what do you hope to learn while here?

If you could develop an advocacy, research, or education project to advance venous and lymphatic medicine, what would that project be and why?

PDF, DOC, DOCX file types only.

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* 4. Please, upload a letter from your preceptor or fellowship leadership explaining your program.

PDF, DOCX, DOC file types only.

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* 5. Please, upload your CV.

PDF, DOCX, DOC file types only.

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* 6. I agree to the terms of the de Groot Award and attest to the information provided in this application. If awarded, I will be available to attend the 2021 Annual Congress in Denver, CO.

Yes