AACN 2018 Annual Meeting Scholarship Application
Dear Applicant,
Thank you for your interest in attending the 16th Annual Meeting of the American Academy of Clinical Neuropsychology (AACN) June 20-23 in San Diego, CA. This year's meeting will feature another outstanding lineup of adult, pediatric, and forensic workshops, as well as a series of student-focused activities, including the annual Student Series, Training Directors’ Hour, and a variety of other opportunities to meet with experienced neuropsychologists and training faculty.
AACN is proud to offer scholarships open to all AACN Student Affiliates who will be first-author presenters at this year’s poster session. The award money can be used to offset the cost of meeting attendance, including conference and workshop registration, travel, lodging, and meals. At least six of the twelve scholarships will be designated as Diversity Scholarships, and the remaining scholarships will be unrestricted. In order to be considered for the Diversity Scholarship, applicants should be either: a) individuals from underrepresented racial and ethnic groups; b) individuals with disabilities; and/or c) individuals from socially, culturally, economically, or educationally disadvantaged backgrounds that have inhibited their ability to pursue a career in health-related professions.
Please submit your completed scholarship application as a single PDF or Microsoft Word document, along with CV in similar format, to the AACN SAC secretary, Stephanie Towns, PsyD, ABPP, at no later than March 15, 2018. Label each document with your first name and then the document title (e.g. Smith Application, Smith CV). Please feel free to contact Stephanie or me with any questions regarding this opportunity.
Sincerely,
Leslie Guidotti Breting, PhD, ABPP
Chair, AACN Student Affairs Committee
APPLICANT NAME: ______
CITY/STATE OF RESIDENCE: ______
DISTANCE TO CONFERENCE:
☐Local ☐Driving Distance☐<2 Hr Flight ☐>2 Hr. Flight
SCHOLARSHIP TYPE:
☐Unrestricted☐Diversity
CURRENT TRAINING STATUS:
Doctoral Student:☐Yr 1 ☐Yr 2☐Yr 3 ☐Yr 4 ☐Yr 5 or above ☐Intern
Postdoctoral Resident:☐Yr 1☐Yr 2
DOCTORAL EDUCATION
Name of Program: ______
APA/CPA Accredited?☐Yes ☐No
Have you graduated?☐Yes ☐No
If no, when do you expect to graduate? ______
RESIDENCY PROGRAM
Name of Program: ______
Houston Conference Guidelines adherent
formal 2-year postdoctoral fellowship?☐Yes ☐No
Name of Training Director: ______
Is the Training Director ABPP
board certified in clinical neuropsychology?☐Yes ☐No
AACN MEMBERSHIP
Are you currently a student affiliate member of AACN?*☐Yes ☐No
AACN PRESENTATIONS
Have you submitted a poster abstract for presentation
at the 2017 AACN Annual Meeting as a first author?*☐Yes ☐No
If more than 1, how many? ______
Have you submitted a poster abstract for presentation
at the 2017 AACN Annual Meeting as a co-author?☐Yes ☐No
If more than 1, how many? ______
STUDENT INVOLVEMENT IN AACN
Are you actively involved (e.g., leadership/service position, volunteer at annual meeting(s), poster presentations) in AACN?
☐Yes ☐No
If yes, please specify: ______
REFERENCES
Primary Reference: ______
Position: ______
Email address: ______
ABPP board certified in clinical neuropsychology?☐Yes ☐No
Secondary Reference: ______
Position: ______
Email address: ______
ABPP board certified in clinical neuropsychology?☐Yes ☐No
PERSONAL STATEMENT
In 500 words or less, please describe the following:
1)Your professional interests and goals
2)How attending the AACN 15th Annual Meeting will help to enhance your professional development
3)Your active involvement in professional organizations related to neuropsychology
4)The ways in which travel to the AACN 15th Annual Meeting will represent a financial hardship for you
[Please include personal statement here]
CURRICULUM VITAE
[Please include CV with application in a Word or pdf document.]
*Required in order to be eligible