Healthier Longer Lives · Scholarship Application 2018

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Scholarship Application 2018

Healthier Longer Lives International Conference

November 8-9, 2018

New York City

Fountain House and the sponsors of the Healthier Longer Lives Conference will award scholarships to exceptional applicants from across the world.

Scholarships can include:

Registration fees to the Healthier Longer Lives Conference on November 8 and 9, 2018 in NYC.
Financial bursary to support travel and/or accommodation costs, provided no local support is available.

PLEASE NOTE BEFORE APPLYING:

You need to answer ALL questions in order to submit the application UNLESS a question is stated as optional.
All applicants must have a working understanding of English, the language of the conference.
Translators are NOT provided at the conference.

Applicant Information

Prefix (Ex. Mr./Mrs./Ms./Miss/Dr.)

Name

First Name

Last Name

Phone with Country Code if Outside the U.S.

Verify Email

Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Nationality

Gender

Do you require a visa to enter the United States?

Yes

Do you require a letter of invitation in support of your visa application?

Yes

Job Title

Organization Name

Website (if applicable)

Upload your bio.

Please list any awards or fellowships you have received. (OPTIONAL)

If available, please list any links to videos, articles or blogs you have been featured in. (OPTIONAL)

Application Essay. Upload your essay here.

Please explain the following in 250 words or less: 1) the value you and your institution will receive from your participation in the conference; 2) the value you and your institution will bring to the conference; 3) your institutional resources (if limited financial resources prohibit your institution from sending you to our conference, please describe the circumstances in your essay. State if you need travel, accommodation, conference registration fees or all of the 3 expenses covered).