National Conference Scholarship Application

Application for Conference Scholarship

National Bleeding Disorders Foundation's Bleeding Disorders Conference or Hemophilia Federation of America's Symposium.
Eligibility: We are offering educational participant grants for members with a bleeding disorder within the Cleveland and Columbus service areas, attending HFA’s Symposium or NBDF's Bleeding Disorders Conference. Grant recipients will be determined through an equitable selection process conducted by a volunteer review team. Members must have an immediate family member affected with a bleeding disorder AND living in their household.

What the Grant Covers: The grant is a reimbursement scholarship with a maximum reimbursement rate up to $1,000 for an individual or $2,000 for a family.

Funds may be used to cover the following:
· Airfare or mileage
· Hotel, for a maximum of three nights
· Registration Fee
· Airport Transportation
· Meals are not reimbursable, as most meals are sponsored at the conference

Reimbursement Guidelines: Reimbursement will be made after receipts are received. If this causes a financial hardship, please contact Tanya: tanya@nohf.org or 216.834.0051 to discuss options available.

There may be additional opportunities to apply through HFA and NBDF to assist in offsetting costs above the local scholarship award.
Date of Application*

MonthDayYear
Date
Name of individual filling out application:*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Cell Number*
Please enter a valid phone number.Format: (000) 000-0000.
NBDF's Bleeding Disorders Conference: August 21-23. 2025, Denver, CO (Application deadline May 1, 2025)HFA Symposium 2026: Date and location not yet released
YesNo
IndividualFamily
Name(s) of the person(s) with the bleeding disorder:*
University Hospitals Cleveland Medical CenterAkron Children's HospitalOhio State UniversityNationwide Children's HospitalOther
SelfParent / GuardianCaregiverSiblingSpouse / PartnerOther
If "Other", please explain or enter N/A:*
Hemophilia AHemophilia BHemophilia with Inhibitorsvon Willebrands Disease (vWD)CarrierRare Factor DeficiencyRare Platelet DisorderOther
If "Other", please explain or enter N/A*
If Rare Factor Deficiency, please list which deficiency, or enter N/A*
If Rare Platelet Disorder, please list which disorder, or enter N/A*
MildModerateSevereN/A
Type 1Type 2Type 3N/A
Hemophilia AHemophilia Bvon Willebrands Disease (vWD)Rare Factor DeficiencyRare Platelet DisorderOtherN/A
If "Other", please explain or enter N/A*
Please explain why you would like to attend this conference:
Yes (Required to attend programs or conferences and receive services)No
I agreeI disagree
Signature of Applicant

Clear
Should be Empty:

Application for Conference Scholarship