Patient Support Meeting Scholarship Application

The PC Patient Support Meetings will be held each year and alternate in USA (odd years) and in UK (even years). Please only apply for scholarship funding for the meeting closest to your home.
Contact Information
Which Patient Support Meeting are you applying for support to attend?
Those answering YES to the following questions will be given special consideration in deciding (a) whether any scholarship funds should be awarded and (b) the amount of the award.
YesNo
This will be my first PC Patient Support Meeting.
I have joined the IPCRR. I have already submitted the Questionnaire and Consent Forms to PC Project and I have scheduled or completed the consultation.
Statement of Need. I will not be able to attend the Patient Support Meeting unless I receive scholarship funds.
So that as many as possible can use the available funds, we ask that you make your request the minimum amount that you need in order to attend the meeting. Travel stipends will be limited to $500 each PC patient.
I am applying for funding for
Total Scholarship funds requested US $
Those who will attend the meeting with me are
You must submit a formal typed essay of 300 to 500 words answering "Why I hope to receive scholarship funds to attend the PC Patient Support Meeting."
You may submit the essay in English or in your own language. The essay will be judged by members of the MSAB and Board of Trustees who will determine the award amounts. You may submit your essay by using the area provided below, or you may mail or email your essay on a separate form to PC Project.