MNHPC Access Scholarship Application

MNHPC Access Scholarship Application

Please fill out the form to apply for a scholarship and provide the necessary details.
Full Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Organization (if applicable)
Role/Title (e.g., nurse, social worker, volunteer, student, administrator)
Years working or volunteering in hospice/palliative care
MNHPC Membership Eligibility
Which best describes your connection to MNHPC?
MNHPC Member Organization
Length of MNHPC membership or employment/volunteer service:
Learning Opportunity Details
Name of conference, training, or learning opportunity
Dates of event
Brief description of the learning opportunity and its relevance to hospice and palliative care
Scholarship Request
Total amount requested: $________
What expenses are you requesting assistance with?

Other
Have you applied for or received other funding for this opportunity?
Describe additional funding sources
Professional Impact & Goals
How will attending this learning opportunity support your professional development or volunteer work in hospice and palliative care? (Short answer – 150–250 words)
How will the knowledge or skills you gain benefit your organization, patients, or community? (Short answer – 150–250 words)
Do you plan to share what you learn with others (e.g., colleagues, volunteers, community partners)? If so, how?
Equity & Access
Please describe any financial barriers that would prevent you from attending without scholarship support. (Short answer – 150–250 words)
If applicable, please share how your background, role, or community connection aligns with the scholarship’s goal of expanding access and inclusion in hospice and palliative care. (Optional)
Applicant Agreement

If awarded a scholarship, I agree to:Use funds only for approved expensesNotify MNHPC if I am unable to attendComplete any requested follow-up or feedback
Signature
Should be Empty:

MNHPC Access Scholarship Application

MNHPC Membership Eligibility

Learning Opportunity Details

Scholarship Request

Professional Impact & Goals

Equity & Access

Applicant Agreement