Apply for a Scholarship to attend the 2018 USCA conference. Information provided on your submission is NOT confidential and will be shared with a committee that reviews all requests. Submission deadline is Friday, June 29, 5:00 pm EST

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Option A: Registration only ($485 value)
Option B: Registration, $100.00 travel subsidy and two nights lodging at conference hotel. (Approximate value: $925)
African-American/Black
American Indian or Alaska Native
Asian
Caucasian or White
Latinx or Hispanic
Native Hawaiian or Pacific Islander
Not Listed
Prefer not to disclose
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Yes
No
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Academic Institution
Community-Based Service Organization (CBO) or HIV/AIDS Service Organization (ASO)
Community Health Center (e.g. Ryan White, Federally Qualified Health Center)
Community/Retail Pharmacy
Pharmaceutical Company
Correctional Facility
HMO/Managed Care Organization
Hospital/Other Healthcare Provider
Rural Health Center
State/Local Health Department
Tribal/Indian Health Service Facility
Not Working
Other
Prefer not to disclose
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Yes
No
  
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