Scholarship Application

1
Name* This field is required.
First Name
Last Name
2
Email* This field is required.
example@example.com
3
Credentials/License* This field is required.
4
Do you identify as BiPoC?* This field is required.
YESNO
5
Are you currently a student, in training, or an early career clinician?* This field is required.
Student
In training (LPC-A, LMSW, psychology intern, postdoctoral psychology fellow, medical resident)
Early career professional (<5 years post-licensure)
6
What type of scholarship are you interested in?* This field is required.
HPS membership
Other
Study Group
7
Please provide the date and title of the study group you are applying for.* This field is required.
8
You chose "other." Please explain.* This field is required.
9
What do you hope to gain from this scholarship?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
10
How will this HPS scholarship further your education and training?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
Should be Empty: