CAPC Scholarship Application

The Center to Advance Palliative Care (CAPC) is subsidizing membership for 30 organizations that demonstrate a capacity to utilize our resources to catalyze care quality improvements. Your organization has been invited to apply. The scholarships are made possible by a generous grant from the Arthur Vining Davis Foundations.

Please complete this application to be considered. Applications are reviewed on a rolling basis or until we reach capacity.

First name

Last name

Title

Phone

Organization name

City/Town

State

Does your organization have a palliative care program/team?

Yes

Does your organization have plans for starting a palliative care program/team?

Yes

Has your organization engaged in any organization-wide clinical training initiatives to train non-palliative care clinicians in palliative care skills (communication skills, symptom management, etc.)?

Yes

Why are you interested in applying for this scholarship? (100 words or less)

How will you implement CAPC resources at your organization if awarded this scholarship? (100 words or less)

Do you have support from hospital leadership to join CAPC membership?

Yes

If my application is accepted and my organization receives this award, engagement activity will be reviewed 90 days prior to the end of the first membership term. If activity does not meet CAPC’s expectations, CAPC reserves the right to discontinue the scholarship and award another organization in our place.

I agree