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 ppsmsecretary@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:
Name
Mailing Address/PO Box
City, State and Zip Code
Phone Number
In what capacity do you work with those in childbearing stages of life? List professional licenses/certifications if applicable.
Are you currently a student, medical resident or intern?
Clear selection
How long have you been involved in this field?
Please describe a life experience that has stimulated your interest in perinatal mental health.
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.
Do you work with underserved populations? If so, please describe.
Do you identify as a provider from an underrepresented community? If so, please describe.
What financial circumstances require you to seek a scholarship to attend the training?
Any other information the Scholarship Committee should be aware of?
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