Application for Conference Stipend

Application for Conference Stipend/Scholarship

Please answer all questions, only complete applications will be considered. Stipends and Scholarships are not Guaranteed.
ATTENDING VIRTUALLY? We now have a sliding scale so there is no need to fill out this form unless you wish to attend in person.
This form is used for all AIU's events so some questions may not apply to the particular event you are attending. In some cases AIU may need to ask some follow up questions.

1. The award amount will depend on the amount of funds available and distance traveled to the conference.
- Level 1 Those living in the city where the conference is being held
- Level 2 Those living within 3 hours driving distance
- Level 3 Those living more than 3 hours away
2. Stipends are a partial or full reimbursment of conference expenses and will be paid after the conference ends.

3. Reimbursment for travel and hotel expenses will only be considered for those providing receipts.

4. AIU subsidizes the conference for all attendees. Your registration fee is only a portion of our cost. Therefore any stipends or scholarships are reserved for those in need.

5. AIU will not share any personal information outside of our organization.
Choose all circumstances which apply to you.

I receive Medicaid or SSI.My loved one receives Medicaid or SSI.I am unable to work due to my AI or the need to care for an affected family member.Other
Check to indicate your agreement even if the question doesn't apply.

I understand that I will need to pay all my own travel and/or hotel expenses in advance.I understand that I am expected to be an active participant in the conference.I understand that this application is not a guarantee of any stipend or scholarship funding.
Full Name of Applicant
Email (double check for accuracy)
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Condition causing adrenal insufficiency (if you do not know write unknown)
Where did you learn about this application? (If FB which group)
IN THE NEXT QUESTION PLEASE LET US KNOW IF YOU ARE ATTENDING IN PERSON OR VIRTUALLY.
IN PERSON - How many including yourself will be attending?
VIRTUALLY - How many including yourself will be attending?
Have you ever attended a conference about adrenal insufficiency or the specific condition you have? (sponsored by any group for example MAGIC Foundation, CARES, Cushing's Support and Research Foundation)

YesNo
Have you attended any AIU conferences before?

YesNo
How long have you or your loved one been diagnosed?

Less than a year1 -5 yearsOver 5 years
Are you

A parent to a child with AIAn adult with AIA spouse/caregiver/family member of an adult with AI
Check any that apply.

I have registered and paid 50% of the conference feeI have made a hotel reservationPlease contact me about making payments towards my registration fee.None of the above
I have answered all questions truthfully and to the best of my ability.

Yes
Should be Empty:

Application for Conference Stipend/Scholarship