IM4US Member Full Scholarship Application for the 2022 IFM Annual International Conference (AIC) Registration  | Accepting Applications through May 9, 2022
ELIGIBILITY

To be eligible, you:
* Must be an IM4US Member
* Must work in or with medically underserved communities. BIPOC practitioners and those working with BIPOC communities are encouraged to apply.

Full scholarships will be awarded to up to 20 recipients to attend the upcoming AIC- Virtual- June 4 -5, 2022. Recipients will be notified by May 12th.
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IM4US Member Full Scholarship Application for the IFM Annual International Conference (AIC) Registration  | Accepting Applications through May 9, 2022
IM4US Member Full Scholarship Application for the IFM Annual International Conference (AIC) Registration .
First Name *
Last Name *
Are you a current IM4US Member? (Membership is required) *
What is your Gender? *
How would you describe yourself? *
Are you hispanic, Latino/a or Spanish Origin? *
Street Address *
City *
State *
Email *
Phone Number *
Primary Degree *
Specialty
Average Number of Patients Seen Per Week* *
Describe the Community You Serve *
Have you previously received an IFM/IM4US scholarship? *
A copy of your responses will be emailed to the address you provided.
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