VAFCC FY2015-16 Scholarship Application

Email completed application toand or Fax 804-340-3435

Questions? Please contact VAFCC at #804-340-3434

Missing information will disqualify the application

The Virginia Association of Free & Charitable Clinics is pleased to announce the availability of several scholarships for FY2015-16 due to the generosity of our Board of Directors’ gifts to the Mel Leaman Scholarship Fund.

Scholarships are being offered to Member Organizationsin good standing with the VAFCC.

Available scholarships include:

CME or CEU programs

Resource Development

Board Development

 Community-based trainings (i.e. United Way workshops)

 Outcome measurement/ data collection

 VAFCC ED and VAFCC & NAFCC Annual Conferences

 New concepts in clinical care

 Pharm Tech certification/training (VAFCC will not pay for license fees for licensed health care providers)

Anything that directly impacts a clinic’s ability to enhance patient care

Scholarship Guidelines:

  • One application per clinic at a time please so that we might share our limited funds with more clinics; multiple requests from a single clinic will be considered if funds are available.
  • Only one scholarship awarded per Member Clinic for either a VAFCC Conference or NAFC Summit (i.e. clinics are not eligible for multiple scholarships; this does not apply to the Psych NP Scholarship)
  • Scholarship recipients will be determined through a review process conducted by VAFCC staff
  • All Scholarship recipients must be a VAFCC Member Clinic or a volunteer or staff member of a member clinic.
  • Scholarships are limited to funding availability.
  • Scholarships may be transferred to another volunteer or staff member within the clinic at the discretion of the clinic Executive Director.

Missing information will disqualify the application

Questions? Please contact VAFCC at #804-340-3434

VAFCC FY2015-16 Scholarship Application

Email Completed Application to and

Or Fax 804-340-3435

Please Type Responses

Missing information will disqualify the application

Questions? Please contact VAFCC at #804-340-3434

Applicant Name
Applicant Position at Clinic (volunteer or staff title)
Name, Date & Location of Workshop/Training/Conference
Amount of Scholarship Requested
Clinic Name
Clinic Address, City, State, Zip
Applicant Phone & Email
Organization’s Current FY Operating Budget
Executive Director’s Signature & Date

By applying for this scholarship, I/we certify that the information provided is true and correct as of the date the application is submitted. If awarded a scholarship, I/we also agree to ALL of the below terms put in place by the VAFCC:

  • If awarded a scholarship, I/we agree that the VAFCC may use my name, title, quotes and photograph in promotional/marketing materials for the VAFCC.
  • I/We agree that, if I/we accept the scholarship, our representative will attend the designated conference/meeting/workshop (i.e. Annual Conference, Executive Director Conference or NAFC Summit) and that if I/we fail to attend the Conference or Summit, I/we will reimburse the VAFCC for all of their costs related to the scholarship program and/or conference costs.
  • I/we acknowledge that the scholarship only covers the cost of one partial conference/workshop registration.
  • If I/we are awarded a scholarship, I/we agree to stay through the entire conference/summit/workshop and will not depart until after the adjournment of the event.

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Why is attending a professional development training important to you and your organization? Please give a brief explanation of the workshop/training including date(s) and location.

Please indicate if you have ever participated in a VAFCC Conference or NAFC Symposium if the scholarship is for one of these meetings.

Maximum answer 325 words – please type responses

Please submit your scholarship request to and or Fax 804-340-3435