2010 Scholarship Application for MeADE Fall Meeting
Eligibility:
1)Priority will be given to MeADE members and students.
2)Applicants are only eligible for a scholarship award once every three years.
3)Applications must be submitted no later than August 23,2010
4)Application should be faxed to Susan MacPherson at Great Gatherings. Fax: 207-622-6228
**The scholarship covers the registration fee for the conference only, participant is responsible for accommodations.

Applicant Information:

Last Name: _____________________________ First Name:__________________________________

Credentials: ________________________________________________________________________

Home Address: _____________________________________________________________________

City/State/Zip: ______________________________________________________________________

Phone Work: ______________________Home:_________________ Fax: ______________________

E-mail:____________________________________ AADE member? ____ MeADE member? ______

Employer: __________________________________________________________________________

Hours you work per week as a diabetes educator: _____ I am currently a student. (PT/FT)__________

Brief description of your job and how you think you could benefit from attending the Fall Meeting:
(If a student, state how this meeting could benefit you.)
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
(Attach an extra page if needed.)

Do you volunteer in a diabetes related organization either helping patients, on committees or as an officer in MeADE or AADE or other similar organization? About how many hours per year?
Please explain: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Explain briefly why you are looking for financial assistance.________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________