Scholarship Application

NCICP Scholarship Fund, 2024

Application Deadline: January 8, 2024

The purpose of the NCICP Scholarship Fund is to provide financial assistance to individuals who are eager to learn about collaboration and partnership best practices to improve immunization uptake, educate our communities, and prevent the spread of disease. With the economic and budgetary challenges that public health partners across the country are facing, funds for conference attendance may be limited.

Disclaimer: We are committed to ensuring that our scholarship application process is accessible to everyone. If you encounter any barriers in understanding or completing your application due to a disability or require any form of assistance or special accommodation, please don’t hesitate to contact us. We are here to help you through this process. Please reach out to immunization@paaap.org with your needs, and our team will promptly assist you in providing the necessary resources or support. Your request for accessibility assistance will not affect the outcome of your application in any way, as we are dedicated to a fair and inclusive application process for all candidates.

Name(Required)

First Last

Preferred Name

Email(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Place of employment/Name of University (students)(Required)

Do you require assistance with the cost of registration only or hotel as well?(Required)

Registration only

Registration & hotel

I will accept any financial assistance that is available

What work do you do in immunization and healthcare? Tell us about the communities you serve.(Required)

How long have you worked in vaccine-related activities?(Required)

Tell us a little bit about why you are applying for a scholarship. How would receiving a scholarships affect you, the work you do, and the communities you serve?(Required)

Demographics

The following information is voluntary, and the information provided will be kept confidential. The purpose of requesting this information is to ensure that every effort is made to create equitable access to the conference through scholarship.

Gender identity (self-describe)

Race/ethnicity (self-describe)

Disability (self-describe)