Cynthia Wachenheim Memorial Scholarship Application
This scholarship is available only to New York providers.

Thank you to the Wachenheim Family and Karen Wachenheim's amazing Zumbathon Fundraisers for this generous and meaningful scholarship fund. May Cynthia's memory be a blessing.

Scholarships are awarded only before a registration; we don't provide refunds to registrations already purchased.
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Email *
Do you live or provide services in New York? (required) *
Are you a member of Postpartum Support International? (PSI) (see http://www.postpartum.net/join-us/become-a-member/) *
Name *
Mailing Address (street or PO Box) *
City, State or Province, ZIP *
Telephone *
Occupation *
Employer
Are you currently a student, medical resident, or intern?
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Briefly describe your involvement in perinatal mental health: *
How long have you been involved in this field? *
Give an example of an experience in your life that has stimulated your interest in this work and your participation in this conference: *
Would you like to use the scholarship to take the certification exam, or to attend a training?
Clear selection
If you would like to take a training, what training would you like to attend? (Please indicate location, or webinar) Here's a link to the trainings. https://www.postpartum.net/professionals/trainings-events/ *
What is the date of the above training?
Briefly describe what specific information, skills or contacts you will be seeking at the training, and how you want to make use of them:
Amount of scholarship request (maximum is $400)
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What financial circumstances require you to seek a scholarship? *
Can you provide bilingual and/or bicultural expertise? *
Have you attended a perinatal mental health training before? *
Is there anything else you’d like the Scholarship Committee to know?
Any other questions?
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