Dr. Robert L. Phillips Scholarship for Vision Related Service Projects
For questions about this scholarship or application, please contact Candice Lee at clee@advancingsight.org.
Name
First Name
Last Name
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Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you currently an ophthalmology resident?
*
Yes
No
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.
Practicing ophthalmologist
Medical student
Nurse
Eye bank employee
Other
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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