You may submit your application:
- Online by submitting this form
- By postal mail (PDF) to ACHA, Scholarship Committee, 6757 Greene Street, Suite 335, Philadelphia, PA 19119
- Fax to 215-849-1261
- Email to firstname.lastname@example.org
(If you plan on submitting your application using numbers 2-4 above please feel free to print this form)
Your privacy is of the utmost importance to ACHA. All information provided on this application is strictly confidential and will not be shared with anyone beyond the Scholarship Committee and selected office staff.
All Scholarship Committee decisions are final.
Please note that the ACHA Patient/Family Conference registration fee is significantly subsidized and covers less than half the per-person conference cost. We offer registration scholarship support for those who would otherwise not be able to attend. Please apply for the MINIMUM scholarship support you need (if any). By doing so, you will help ensure that as many individuals as possible can participate in the upcoming event. Thanks in advance for your willingness to help us do all we can for our community!