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HFMA Georgia Chapter Provider Scholarship Application 2018-19

 

The purpose of the provider scholarship program is to help defray cost of the attending the HFMA Georgia Chapter Fall Institute for healthcare professionals that are members of HFMA and are employed with healthcare providers, such as hospitals, physician practices, etc. The amount and quantity of scholarships awarded will depend on the funding and specific underwriting received by sponsors.

 

Scholarships will be awarded based on several criteria, including:

  • Current HFMA member
  • HFMA volunteer involvement
  • Diversity in provider based applicants
  • Number of applicants
  • Available funding and sponsorships

 

Scholarships can be used to cover the registration fees and up to two nights at the host hotel. Travel expenses not included.

 

The Scholarship winners will be determined based on blind (name, contact and company information of applicant hidden from judging panel) voting by the members of the HFMA Georgia Chapter Education Content/Logistics Planning Committee. All awards are final and based solely on the discretion of this committee.

 

Any scholarship awarded but not utilized (for example attendee was awarded a scholarship covering the conference registration fee but was unable to attend) may be given to other applicants at the sole discretion of the HFMA Georgia Chapter President during the conference. 

 

Please submit your completed application to laurenceh@triageconsulting.com 

 

By applying for the scholarship program, you confirm that only the expenses that are considered non-reimbursable by your employer will be submitted for reimbursement under the scholarship program. Please direct any questions regarding the scholarship program to Laurence Harris, Program Chairperson for the HFMA Georgia Chapter at laurenceh@triageconsulting.com













Please print this page and send to laurenceh@triageconsulting.com


Applicant Information –

Name:

 

Company:

 

Address:

 

City:

 

State:

 

Zip Code:

 

Email address:

 

Phone Number:

 

HFMA Membership Number

 

Employer Type of Healthcare Organization –

___ Hospital/Health System 

___ Physician Office/Group

___ Long Term Care Provider

___ Other (please specify) ________________

Requested Scholarship Level – Please include all that apply (excludes food and entertainment)

____ Conference Registration Fee

____ Hotel Room Cost (3 nights at the conference hotel)

In your own words, why do you believe you should receive a scholarship to this event: