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Resident Travel Award Application for AACAP Advocacy Day

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Resident Travel Award Application for AACAP Advocacy Day

  1. 1. AACAP Advocacy Day May 10-11, 2012 Resident Travel Grant ApplicationWith the support of AACAP’s Campaign for America’s Kids, AACAP is providing travel grants of$250 to child and adolescent psychiatry residents to attend Advocacy Day. These travel grants mustbe matched with support from your regional organization. Regional organizations can select up totwo residents to support. The scholarships will be awarded on a first-come-first served basis. All applications must be submitted with a letter of support from your regional organization president, acknowledging matching support.Name: ________________________________________________________________HOME Address (where you vote):______________________________________________________________________City: ____________________________ State: ___________ Zip Code: ___________Phone #: ______________________ Email: __________________________________Regional Organization: ___________________________________________________I will ___ will not ___ attend the Thursday afternoon Advocacy Training.I will ___ will not ___ attend the Thursday evening Reception. The deadline for applications is April 13, 2012. Please submit all materials to Liz DiLauro at edilauro@aacap.org or fax to 202-966-1944. This program was made possible by a grant from the American Academy of Child and Adolescent Psychiatry’s Campaign for America’s Kids.

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