Scholarship Application


5th International CCHS Conference: The Future is NOW—Priorities, Partnerships, and Patient Voice


Please complete this application for scholarship and upload your physician’s recommendation to be considered to receive a scholarship to attend this conference.
Scholarships are intended to help individuals/families attend the conference.

Scholarships will cover the cost of:

  1. One (1) hotel room (double occupancy) for no more than 4 occupants for one (1) to three (3) nights
  2. Travel expenses up to $400.00

Scholarships are limited. To be considered for financial assistance, this form must be returned to the planning committee before March 1, 2018.
Scholarships will be awarded by March 31, 2018. Please contact Melinda Riccitelli if you have questions or need help with this form.

Physician’s Recommendation

Please upload a recommendation from your CCHS physician explaining how you would benefit from attending.