Dr. Robert L. Phillips Scholarship for Vision Related Service Projects
For questions about this scholarship or application, please contact Candice Lee at firstname.lastname@example.org.
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Street Address Line 2
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Postal / Zip Code
Are you currently an ophthalmology resident?
If you are an ophthalmology resident, please list your residency program and your current year in that program.
Name of your ophthalmology residency program & what year you are in currently.
If you are not currently an ophthalmology resident, please choose the options that describe your experience.
Eye bank employee
Are you affiliated in any way with an Advancing Sight Network eye bank? Please briefly describe.
Briefly describe your education and/or work experience.
Please select the start and end dates for your project.
Describe the Vision-Related Service Project you have planned. Please include details about what you will be doing, the population you will be serving, etc. If you are participating with an organization or a group, please include this information.
What is the total amount of scholarship assistance you are requesting from this scholarship?
If awarded this scholarship you will be asked to submit a brief report of your experience to be shared with the Advancing Sight Network Board, scholarship donors, and future applicants.
I agree to submit a report following my service project
Please upload your current resume or CV.
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Please provide contact information (name, email and/or phone number) for one reference - a supervisor, work colleague, professor, etc. who can vouch for you.
Is there anything else you would like us to know about you or about your project?
Please verify that you are human
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