Allied Health Professionals Award

Award Application

Name*

Credentials*

Email*

Phone*

Title*

Stipend or Award*

Stipend

Award

Name of Institution or Practice*

Address Line 1*

Address Line 2*

City*

State*

Zip Code*

Why are you applying for this award?

Should your application be selected, what meeting(s) and/or certification(s) would this award be used for?

How would winning this award help advance your career? Please explain your professional objectives and/or goals.

Is there any additional information you would like us to consider?

Are you a current member of the Wisconsin Association of Hematology and Oncology?*

Yes

I don't know

In order for your application to be considered, you must be a current Associate Member of the Wisconsin Association of Hematology and Oncology (WAHO). If you would like to submit an application and are not a member of the society, or do not know your membership status, please email our Membership Department or call 301.984.9496 ext. 217. For more information regarding the benefits of WAHO membership, please click here.