The Big IDea: Infectious Diseases/HIV Education & Advocacy Day Travel Assistance Application

Thank you for your interest in the Big IDea: Infectious Diseases/HIV Education & Advocacy Day that is being co-sponsored by IDSA and HIVMA on Oct 1 in Washington, DC. A limited number of scholarships to offset travel and lodging are available. Fellows-in-training, members who have recently completed training, and others who can demonstrate need will be prioritized for assistance. To apply, please complete the questions below by June 3rd. We will notify financial assistance recipients in July.

Question Title

* 1. Contact Information

Name

Degree

Employer

Employer Street Address

Employer City

Employer State

Home Street Address

Home City

Home State

Email Address

Question Title

* 2. Are you a member of any of the following organizations (please check all
that apply)?

IDSA

HIVMA

SHEA

PIDS

Question Title

* 3. How would you describe your primary role in ID/HIV?

Fellow-in-Trainee

Medical Resident

Medical Student

Researcher

Researcher/Clinician

Public Health Practitioner

Private Practitioner

Other (please specify)

Question Title

* 4. Within which areas of ID do you have expertise? (please check all that apply)

HIV

Antimicrobial resistance

Viral hepatitis

Infections related to injection drug use

Bacterial infections

Fungal infections

Parasitic infections

Global Health

Diagnostics

Other (please specify)

The Big IDea: Infectious Diseases/HIV Education & Advocacy Day Travel Assistance Application

Question Title

* 1. Contact Information

Question Title

* 2. Are you a member of any of the following organizations (please check all
that apply)?

Question Title

* 3. How would you describe your primary role in ID/HIV?

Question Title

* 4. Within which areas of ID do you have expertise? (please check all that apply)

Question Title

* 5. Why are you interested in participating in the advocacy day?

Question Title

* 6. Statement of Need for Support (Please provide a few sentences describing your need for financial assistance):

Question Title

* 1. Contact Information

Question Title

* 2. Are you a member of any of the following organizations (please check all that apply)?

Question Title

* 3. How would you describe your primary role in ID/HIV?

Question Title

* 4. Within which areas of ID do you have expertise? (please check all that apply)

Question Title

* 5. Why are you interested in participating in the advocacy day?

Question Title

* 6. Statement of Need for Support (Please provide a few sentences describing your need for financial assistance):

* 2. Are you a member of any of the following organizations (please check all
that apply)?