AHA/Wyeth-AyerstWOMEN IN CARDIOLOGY TRAVEL GRANT PROGRAM

The AHA Council on Clinical Cardiology Committee on Women in Cardiology is pleased to announce atravel grant program for women cardiology fellows. The purpose of this grant is to encourage andrecognize outstanding academic and clinical performance during cardiovascular-related specialtytraining. The grant subsidizes travel expenses to the American Heart Association's annual meeting andattendance at the Women in Cardiology professional development program.

Outstanding trainees from ACGME or AOA approved training programs may apply to receive a $1,000travel grant to subsidize meeting registration, airfare, hotel and meals for travel to the American HeartAssociation’s Scientific Sessions, November 11-17, 2002, in Chicago, IL.

This grant is intended to acknowledge outstanding trainees who exemplify a balance between clinicalexpertise and scientific interests. While applicants may be actively engaged in research and haveassociated publications, this is not a requirement for application and selection.

The application is to be made on the enclosed form and should not exceed these two pages. The firstpage must be endorsed by the training director, and the remainder of the application incorporates astatement written by the candidate outlining how receipt of this grant will further career objectives.

The AHA must receive applications for the 2002 Travel Grant, Attention: Shannon Gideon by August 1,2002. Selection of the trainees will be confirmed no later than September 1, 2001.

If you have further questions, please feel free to contact Shannon Gideon at shannon.gideon@heart.org.

AHA/Wyeth-AyerstWOMEN IN CARDIOLOGY TRAVEL GRANT PROGRAM

APPLICATION FORMDeadline for Receipt of Application: August 1, 2002

PLEASE TYPE

NAME: Date of Birth: Last, First and M.I. Degrees

Preferred Mailing Address:

Daytime Phone ____ Fax __________________ Email _____________________

Fellowship Training Program: Institution: __________________________

Fellowship Year (1/2/3 etc.)____ Name of Training Program Director: _____________________

Check Payable to: Institution Trainee_______ Social Security Number: _____________

Ethnic Origin (circle) White, Black, Hispanic, Native American or Asian Pacific Islander) Education: Name/Location of Institution Date Graduated Degree

College or University:

Medical School:

Post Graduate Training: Appointments (e.g. Internship/Residency/Fellowship)

Name and Location of Institution Area of Specialization Inclusive Dates If selected, I will attend the American Heart Association Scientific Sessions 2002 and theWomen in Cardiology professional development program on Nov. 11-17, 2002, in Chicago, IL

q AHA Abstract Submitted q Attended Prior AHA Sessions

Signed: Nominee's Signature Date

TRAINING PROGRAM DIRECTOR'S ENDORSEMENT (ACGME - or AOA - approved programin Cardiology) I certify that this candidate is enrolled in our program.

Signed: Training Program Director's Signature Date

PLEASE RETURN THE APPLICATION TO THE AMERICAN HEART ASSOCIATION BY:AUGUST 1, 2002. APPLICATIONS EXCEEDING TWO PAGES MAY BE DISQUALIFIED.Shannon Gideon, Women in Cardiology, AHA, 7272 Greenville Ave. Dallas, TX 75231

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Travel Grant Application, Page 2

NOMINEE'S PERSONAL STATEMENT: Please confine to one page a personal statement outlining:1) how receipt of the Women in Cardiology Travel Grant will further your professional developmentand goals; 2) your research and clinical interests; 3) any publications and presentations at meetings,and 4) any additional information pertaining to your choice of cardiology as a career.