ASFA 2021 Scholarship Application

Key Dates
Application Deadline: January 29, 2021
Notification of Outcome: March 2021
ASFA 2021 Virtual Meeting: May 12-15, 2021

Additional documentation to support your applications must be emailed to asfa@apheresis.org by January 29, 2021

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* 1. First Name

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* 2. Last Name

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* 3. Credentials (RN, MD, MBBS, etc)

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* 4. Title

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* 5. Email

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* 6. Institution

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* 7. City

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* 8. State

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* 9. Country

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* 10. Membership Type

Allied Health

Physician

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* 11. Essay
Please provide a brief essay on the topic, “What I Hope to Gain by Attending the ASFA 2021 Virtual Meeting” (150 words max)

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* 12. Eligibility Pathways
Please select which of the following pathways that your application is eligible for:

Abstract submission to the 2021 ASFA Annual Meeting

The 2021 ASFA Annual Meeting must be the applicant’s first ASFA Annual Meeting
ASFA Head Office will verify with the registration lists of past ASFA Annual Meetings.

Allied Health Professional practicing apheresis for three years or less
Please provide documentation confirming that you are an Allied Health Professional that has been practicing apheresis for three years or less, such as written confirmation from your employer.

Registered to take the Qualification in Apheresis (QIA) exam
Please provide documentation confirming that you have paid the $240 USD application fee, such as the payment receipt from the ASCP Board of Certification. The date of this receipt cannot be earlier than October 1, 2019

Please provide the title of your submitted abstract if applicable

ASFA 2021 Scholarship Application

Question Title

* 1. First Name

Question Title

* 2. Last Name

Question Title

* 3. Credentials (RN, MD, MBBS, etc)

Question Title

* 4. Title

Question Title

* 5. Email

Question Title

* 6. Institution

Question Title

* 7. City

Question Title

* 8. State

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* 9. Country

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* 10. Membership Type

Question Title

* 11. EssayPlease provide a brief essay on the topic, “What I Hope to Gain by Attending the ASFA 2021 Virtual Meeting” (150 words max)

Question Title

* 12. Eligibility PathwaysPlease select which of the following pathways that your application is eligible for:

* 11. Essay
Please provide a brief essay on the topic, “What I Hope to Gain by Attending the ASFA 2021 Virtual Meeting” (150 words max)

* 12. Eligibility Pathways
Please select which of the following pathways that your application is eligible for: