Application Deadline: August 20, 2021

Thank you for your interest in the ALS Clinical Research Learning Institute® (CRLI). The 11th Annual NEALS CRLI will take place online October 8 - 9, 2021. People living with ALS, caregivers, and surviving family members who have not attended a previous CRLI are encouraged to apply. For more information about the CRLI program, please visit the NEALS website

All applications are due Friday, August 20, 2021. If you have any questions, please contact Carly Allen at callen@neals.org.

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* 1. Contact Information

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* 2. I am a:

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* 3. Current clinic being utilized for ALS care (if applicable):

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* 4. Nominated by (if not self-nominated):

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* 5. Please describe why you would be a great ALS Research Ambassador. Tell us about qualifications, experience, and plans for utilizing this training:

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* 6. Spots are limited for each CRLI. If you're not selected to attend the virtual CRLI in October, would you like to be notified about future CRLIs?

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* 7. If you’re selected to attend the 2021 NEALS CRLI, will anyone from your household be participating in the virtual meeting with you?

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* 8. If you answered yes to question #7, please provide contact information for the additional attendee.

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