2024 International Congress on Integrative Medicine and Health - Diversity & Inclusion Scholarship Application

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* 1. Name of Applicant:

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* 2. Name of Institution:

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* 3. Title:

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* 4. Email Address:

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* 5. Country:

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* 6. Degree/Credentials:

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* 7. Are you a current student or trainee?

Yes

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* 8. If yes, please briefly describe your program (e.g. MSN program, medical residency, DACM program, etc.)

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* 9. Please check all eligibility criteria that apply:

Black or African American

Hispanic / Latinx

American Indian

Alaska Native

Native Hawaiian

Pacific Islander

Individual with disabilities (defined as those with a physical or mental impairment that substantially limits one or more major life activities)

LGBTQIA+

Other: Do you feel you are part of an underrepresented group not listed here? For consideration, please apply and explain.

2024 International Congress on Integrative Medicine and Health - Diversity & Inclusion Scholarship Application

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* 1. Name of Applicant:

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* 2. Name of Institution:

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* 3. Title:

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* 4. Email Address:

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* 5. Country:

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* 6. Degree/Credentials:

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* 7. Are you a current student or trainee?

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* 8. If yes, please briefly describe your program (e.g. MSN program, medical residency, DACM program, etc.)

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* 9. Please check all eligibility criteria that apply:

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* 10. If you selected "Other" from the eligibility criteria above, please use this area to explain your reasoning:

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* 11. How will your participation at the Integrative Medicine & Health Symposium contribute to your professional growth?

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* 12. How will you plan to share knowledge from the Integrative Medicine & Health Symposium in your work or academic studies?