Training Scholarship Request Form
This application is for those interested in any PPSM Training. Priority with be given to professionals working with underserved populations (rural areas, non-English speaking, uninsured) or providers from an underrepresented community. MINNESOTA residents only. If you have questions please email ppsmadmin@gmail.com Deadline is two weeks prior to each scheduled training. Applications will be reviewed and you will be notified as soon as a possible.
Email address *
Please note the name and the date of the training you are applying for:
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Name
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Mailing Address/PO Box
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City, State and Zip Code
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Phone Number
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In what capacity do you work with those in childbearing stages of life? List professional licenses/certifications if applicable.
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Are you currently a student, medical resident or intern?
How long have you been involved in this field?
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Please describe a life experience that has stimulated your interest in perinatal mental health.
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Briefly describe what specific information, skills or contacts you will be seeking at the training and how you want to use them in the community.
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Do you work with underserved populations? If so, please describe.
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Do you identify as a provider from an underrepresented community? If so, please describe.
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What financial circumstances require you to seek a scholarship to attend the training?
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Any other information the Scholarship Committee should be aware of?
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