SC HIV, STD, and Viral Hepatitis Scholarship Information

TheSouth Carolina HIV, STD, and Viral Hepatitis Conference will be held October 29-30, 2014 at the ColumbiaMetropolitan Convention Center in Columbia, S.C. Conference attendees will have the opportunity to learn new facts about HIV, STD, and HCV treatment, prevention, and care.

Twenty scholarship opportunities are available. Scholarships are intended to assist persons living with HIV/AIDSwho would not be ableto attend the Conference without assistance. To apply for a scholarship you must fill out the forms and provide all required documents in one packet by the due date. Incomplete application packets will not be considered. Completed application packets should be sent to the address below*.

The scholarship pays for the conference registration fees only (including breakfast and lunch).Scholarship recipients will beresponsible for all travel and hotel costs. You may want to ask your local CBO (Community Based Organization) or ASO (AIDS Service Organization) if they can sponsor your travel and/or hotel costs before you complete this application for a scholarship.

  • Yourapplication must be received bySeptember1, 2014(NO EXCEPTIONS).
  • You must fill out every part of the form. Incomplete applications will NOT be reviewed.
  • You must send completed application forms and supporting documents to: Conference Scholarships C/O AID Upstate, Attn: Teretha Fowler, P.O. Box 105, Greenville, SC 29602. Faxed and E-mailed forms will NOT be accepted.

If you are chosen for a scholarship, we will contact you by September 12,2014.

Please read everything below and fill out the Scholarship Application

1 ContactInformation: Please print the name, address, and contact information of the scholarship applicant. All information will be kept confidential and will NOT be shared with anyone else. Please print neatly or type this information. Fill in your complete name, mailing address, and phone number.

2Statement of Interest: Please submit a one page statement explainingwhy you want a scholarship for this conference. Tell us what you will do as a result of attending the conference. Please give us as much information as you can so we may select the best applicants.

3Recommendation: A recommendation is a letter that must come from your ASO (AIDS Service Organization), doctor, case manager or care provider. The Scholarship Committee anticipates more applications will be received than can be funded; therefore, scholarships will be selected through a competitive process. We will use this letter to make sure you qualify for the scholarship and to assist in the selection process. Have the person you choose write a letter of recommendation and attach it to your application form.

4Buddy System: If this is your first time attending the conference, you may be nervous about coming alone. If you are nervous, we can help. If we choose you for a scholarship you can sign up to have a “buddy” at the conference. This “buddy” would be a person who has been to the conference before. He or she can show you around, help you meet new people, and help you choose which sessions to attend. If you would like to have a “buddy” at the conference, put a checkmark in the “Buddy” box on the form.

REMEMBER…

DEADLINE ISSEPTEMBER 1, 2014!! If it is late, the review team will not read it! If you have questions, please call TerethaFowler at(864) 250-0607 or email . Mail applicationforms to:

*HIV, STD, and Viral Hepatitis Conference Scholarships, c/o AID Upstate

Attn: Teretha Fowler

P.O. Box 105, Greenville, S.C. 29602

SC HIV, STD, and Viral Hepatitis Scholarship ApplicationForm

1 Contact Information: If you wish to apply for a scholarship to attend the SC HIV, STD, and Viral Hepatitis Conference, please fill this part out. Directions and more information are on other side of this page.

CONTACT INFORMATION

Name: Address:

City, State, Zip Code:

Phone Number: Email:

Have you ever received a Scholarship from the SC HIV/STD Conference? YesNo

If yes how many years have you received a Scholarship? Which Year(s)?

Please indicate the year(s) you have attended the SC HIV/STD Conference:

2Statement of Interest: On a separate sheet of paper please tell us: (1) why you want a scholarship to attend this conference, (2) what will you do as aresult of attending the conference, and (3) how attendance will benefit you. Please give us as much information as you can to help the Scholarship Committee make a selection. Limit one page.

3Recommendation: A one page letterof recommendation is REQUIRED from the applicant’s ASO, doctor, case manager or care providerand must be included in the application packet. The letter should clearly state why the reference feels that the applicant has the interest, availability, ability, and commitment to provide support to help with education, prevention/intervention, and/or care services efforts in your community. The letter mustinclude information regarding the applicant’s work and life experiences, along with interpersonal skills the applicantpossesses that will assist them with providing education, prevention, intervention and care services. The reference should share their observation of specific work that the applicant has been engaged in or completed in the community. (For Example: The applicant volunteers each week to greet clients and to answer the telephone at the Prevention Resource Center and serves as a mentor.)

4 Buddy System: If you are coming to the conference for the first time and want a “Conference Buddy,” please check the box below:

Yes, I would like to have a buddy.

PLEASE NOTE: DEADLINE IS SEPTEMBER 1, 2014Applications received after September 1stwillNOT be accepted! Incomplete applications will NOT be reviewed. Faxed and e-mailed applications will NOT be accepted. If you have questions, please call Teretha Fowler at (864) 250-0607 or email . This application form should be mailed to:

HIV, STD, and Viral Hepatitis Conference Scholarships, c/o AID Upstate

Attn: Teretha Fowler

P.O. Box 105, Greenville, S.C. 29602

SC HIV, STD, and Viral Hepatitis Scholarship Check List

**Scholarship Check List Must Be Included Inthe Scholarship Application Packet**

Eligibility Requirements and Guidelines

  • Only South Carolina residents are eligible to apply.
  • Only people living with HIV/AIDS (PLWHA) are eligible to apply.
  • Applications must be submitted by September 1, 2014.

Please place a check by each item included in your packet.

Incomplete applications and/or packets will NOT be considered.

I meet all eligibility requirements listed above.

My scholarship application form is included and all questions are answered completely. I did not leave any section blank.

My one-page statement of interest is included.

A letter of recommendation is included from my AIDS Service Organization (ASO), doctor, case manager or care provider.

I HAVE READ AND SIGNED THE STATEMENT BELOW AND THIS FORM HAS BEEN INCLUDED IN MY PACKET.

I UNDERSTAND THAT THIS SCHOLARSHIPPAYS FOR THE CONFERENCE REGISTRATION FEES ONLY (INCLUDING BREAKFAST AND LUNCH). I AM RESPONSIBLE FOR MY OWN LODGING AND TRASPORTATION. I UNDERSTAND THAT I WILL BE EXPECTED TO TAKE FULL ADVANTAGE OF ALL SESSIONS. I WILL NOTIFY THE SC HIV, STD, AND VIRAL HEPATITIS CONFERENCE SCHOLARSHIP COMMITTEE IMMEDIATELY IF I AM NOT ABLE TO ATTEND OR IF THERE ARE CHANGES IN MY CONTACT INFORMATION. I UNDERSTAND THAT SCHOLARSHIPS ARE NON-TRANSFERABLE.

Signature of Applicant:

Date: