AWHS Overseas Grant Application

The AWHS Overseas Assistance Grant provides assistance with transportation costs up to $1,000 connected with pursuing medical studies in an off-campus setting where the medically neglected will benefit. The Grants are awarded to full national AMWA members completing their second, third or fourth year of an accredited U.S. medical or osteopathic medical school or a resident who will be spending a minimum of four weeks and no longer than one year in a sponsored program which will serve the needs of the medically underserved. Priority will be given to those applicants who have been actively involved with AMWA, either at the local or national level, throughout their training thus far and whose projects are focused on benefitting women and children. Priority will also be given to applicants who intend to remain members of AMWA as they advance in their careers.

The completed application and supporting documentation must be forwarded to AWHS by deadline (January 5, May 5, and September 5). A decision will be made not later than 6 weeks following the deadline. The following items must be submitted electronically to AWHS@amwa-doc.org before an application will be considered:

Completed Overseas Assistance Grant Application
Letter from the Dean’s Office confirming your good standing (not applicable if you are a Resident)
Letter of Recommendation from a faculty member
Evidence of school approval for academic credit and acceptance of responsibility
Description of the program prepared by its sponsor or, if no sponsor, by your school or another school accepting responsibility
Travel Budget

Applicants will be charged a one-time, nonrefundable $10 proceesig fee.

At the conclusion of the study, the Overseas Assistance Grant recipient must submit:

A photo essay or video or educational article summarizing the experience that can be used as a focused educational piece in an AWHS newsletter submission
A final expense report with receipts for travel expenses over $25.00 incurred traveling to and from the site.

Grant awardees will be asked to participate in the AWHS committee for the remainder of the year. We would also encourage and try to support attendance at the AMWA annual conference to present your work.

Full Name*

First NameLast Name

E-mail*

Phone Number

Area CodePhone Number

Permanent Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Destination:

Departure Date:

Length of Stay:

Are you an AMWA Member?

YesNo

List dates of AMWA membership.

Please explain your level of involvement with AMWA.

Do you plan to remain an AMWA member as you advance in your career?

YesNoMaybe

Have you been active with other Women’s Health Organizations?

YesNo

If yes, which organization(s)?

Are you applying for any additional sources of funding?

YesNo

If yes, which ones?

ACADEMIC AND PROFESSIONAL HISTORY

Undergraduate College:

Matriculation (Month/Year):

Graduation (Month/Year):

Degree:

Medical School:

Matriculation (Month/Year):

Graduation (Month/Year):

Degree:

Other Schools:

Matriculation (Month/Year):

Graduation (Month/Year):

Degree:

Planned Specialty:

PERSONAL REFERENCE

Please provide the name of a personal reference and include a letter of recommendation from that individual with your application.

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

Email

example@example.com

Letter of Recommendation:

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TRAVEL BUDGET(airfare costs and any anticipated other expenses for this trip) You can also upload budget.

Travel Budget:

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How might you be able to use this experience to educate future students who plan to travel abroad or work in a medically underserved area?

How will the grant help you advance knowledge in a particular area of medicine or public health?

What is the projected impact of your proposed project on the community?

How does your project impact women and children in the community?

Please submit a 600-800 word statement on why you want to travel to this particular program, why it is more valuable for you than staying on campus, what you particularly plan to accomplish during your stay, and how you hope the experience will benefit both yourself professionally and the community in which you will work

Personal Statement (you can also upload file):

Personal Statement document:

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Processing fee$10.00

Application processing fee

Total $0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

American Women’s Hospitals Service OVERSEAS GRANT APPLICATION

Project Rationale and Impact