Scholarship/Grant Application Form

Scholarship/Grant Application Form 2017-06-27T17:10:13+00:00

Contact Information

College

Medical School

Residency

YesNo
YesNo


"I understand that if my application is accepted and I am given this grant, I will be responsible for my own actions and further agree to release and hold harmless the American Osteopathic Colleges of Ophthalmology and Otolaryngology-Head and Neck Surgery Foundation, Inc., their agents and employees from any damages, liabilities or expenses they incur by reason of my actions of whatever nature or kind in connection with this award. I agree to fully accept responsibility for all personal insurance I deem necessary should I receive this grant."

Address application and questions to:
Stephanie Whitmer, Administrative Director
AOCOO-HNS Foundation, Inc.
142 East Ontario Suite 1500
Chicago, IL 60611
phone 800-455-9404
e-mail swhitmer@aocoohns.org