AARBF Phoenix Virtual World Burn Congress Scholarship Application 2020
The Alisa Ann Ruch Burn Foundation Phoenix Virtual World Burn Congress Scholarship provides financial assistance to cover costs for registration to participating in the Phoenix Society’s World Burn Congress.

The Phoenix Society’s Virtual World Burn Congress offers a unique atmosphere of burn survivors, families, healthcare providers, burn professionals, and firefighters who come together as one caring community of support. People come to learn, grow and share their amazing experiences. Many people have described the experience as a life-changing moment in their lives. It is a forum for encouraging and facilitating the sharing of stories, providing support and increasing knowledge of burn recovery. Whether you are a survivor, parent of a survivor, or a family member/caregiver you will find that World Burn Congress offers a healing environment for all.  To learn more about the Phoenix Society and Phoenix World Burn Congress , visit www.phoenix-society.org.

Scholarship Requirements:
Qualifying applicants must be burn survivors, parent of a burn survivor, or family member/caregiver and had his or her life and livelihood impacted by the burn or is involved in the recovery of the survivor. Applicants must reside in California, have been treated overnight in a burn center (for burn survivors), demonstrate financial hardship and meet at least one the following requirements:

Have attended or volunteered at AARBF or burn community event (i.e. burn support groups, holiday parties, recreational event, etc.);
Have been recommended to attend Virtual World Burn Congress by an affiliated Burn Center or Burn Care Professional.

Application Process:
In order to be considered for the Alisa Ann Ruch Burn Foundation’s Virtual World Burn Congress  Scholarship, all documents must be completed and submitted no later than September 25 , 2020 at 5:00pm. An application must be submitted for each individual requesting a Scholarship (i.e. burn survivor and caregiver or spouse).

Other Important Dates:

Application Deadline: August 30, 2020 5:00PM
Status Notification: TBD
Conference Dates: TBD
Survey Due: TBD
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First and Last Name *
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Date of Birth
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Age
Address *
City, State, Zip and County *
Home Phone
Cell Phone *
Email *
I am a: *
I am applying for: *
Please provide names of all persons attending Virtual World Burn Congress: (Each person seeking scholarship funding must complete a separate application)  
If only applying for the Youth and Family Programming give family name:
Please tell us about yourself. Include information about date of burn, cause of burn and where you are at in your recovery process. If you are a parent of a burn survivor or family member/caregiver please include information about the survivor, as well as what role you have personally played in the survivor’s recovery process.  Please be as detailed as possible with a minimum of 250 words. *
Do you want your information provided above to be confidential? *
Have you attended or volunteered for any Alisa Ann Ruch Burn Foundation or burn community events (i.e. support groups, holiday parties, Champ Camp, etc.) ? *
Please list any Alisa Ann Ruch Burn Foundation or burn community events (i.e. support groups, holiday parties, Champ Camp, etc.) that you have attended or volunteered for:
Have you attended World Burn Congress in the past?     *
If you have attended World Burn Congress in the past, how many times have you attended? *
Will you have access to the following device(s) for virtual programs? (Select all that apply) *
Required
If you checked none, will you have access to view virtual programming through other means?   *
Do you have consistent connectivity to the internet to attend virtual programs? *
Do you agree to AARBF's Code of Conduct?                                                                                                        I agree to represent the Alisa Ann Ruch Burn Foundation appropriately at all times. As a recipient of the Alisa Ann Ruch Burn Foundation’s Virtual World Burn Congress Scholarship, I understand that I must: Prior to the Virtual World Burn Congress, complete the scholarship application; Prior to the Virtual World Burn Congress, submit a completed Photo, Video and Media Release Form; Attend all sessions applicable for Virtual World Burn Congress. (exceptions may be considered); After Virtual World Burn Congress, summit a completed survey on November 2, by 5:00pm to the Alisa Ann Ruch Burn Foundation. Although not required, please send any photos for Virtual World Burn Congress to info@aarbf.org. Your photos will help with marketing and social media. By selecting "yes", you certify that the information provided on this application is complete and correct to the best of your knowledge. You further certify that if you are chosen as a scholarship recipient, you will use the funds only for expenses related to Virtual World Burn Congress. You understand that all burn survivors, parent of a burn survivor or family members/caregivers will be considered for the Virtual World Burn Congress, however burn survivors with the greatest financial need will be given priority. *
Do you agree to AARBF's Photo, Video and Media Release?  The Alisa Ann Ruch Burn Foundation needs your help and support in its work of providing educational programs about burn injuries. Often, as people become aware of how to prevent burns, they also want to support programs to help survivors of burn accidents. You can help our efforts to increase support for the valuable programs in which you participate. We need your authorization. Check next to the appropriate answer and then give your signature.   Yes, I provide consent for the Alisa Ann Ruch Burn Foundation to use photographs and video of Virtual World Burn Congress for use on the AARBF website, newsletter and Facebook page.  I understand that my last name, the cause of my burns, and any other sensitive personal information will not be revealed without my specific consent. No, I do not provide consent to use photographs and video of Virtual World Burn Congress for use on the AARBF website, newsletter and Facebook page. NOTE; checking this option does not disqualify you from being awarded the Virtual World Burn Congress scholarship. *
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