Grant application

2017 - Grant application



Application for Annual Meeting Grant


If you would like to apply for a grant, please fill out the following information.

Grant assistance for attending the meeting will be considered for the following types of individuals:
1. Ophthalmology residents or fellows.
2. Medical students planning an ophthalmology residency.
3. Support based ophthalmic missionaries.

Last Name(*)
Please type your full name.

First Name(*)
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Home Address(*)
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City(*)
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State(*)
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Zip Code(*)
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E-mail(*)
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Cell(*)
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Classification(*)

Please specify your current position.

Institution Name
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Training level at time of conference (if applicable)(*)

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If I present a poster or talk, my program will support me attending this event financially

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If so, how will they support this event?
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Do they support travel, housing or registration or all?

I will be traveling:(*)
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Check all that apply.

If traveling by yourself, what nights will you plan to stay overnight?

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If you are coming by yourself and wish to specify a roommate, please do so here.
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How did you hear about the COS?(*)
You must enter a diagnosis

I have attended the COS annual meeting before

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Number of prior meetings attended
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I potentially have a strong faith testimony to share.
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Please share any comments
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Get In Touch

  •  333 Whitesport Center - Suite 101
      Huntsville, AL  35801
  •  269-697-1COS
  • [email protected]