2025 Scholarship Submission Form

Name *

First

Last

Title

College/University/Organization *

(If you are a student, please state your major and whether you are an undergraduate or a graduate student.)

Discipline (e.g. public health, nursing, health care administration, medicine, physician assistant, PT, OT, psychology, counseling, etc) *

Email *

Confirm Email

County of Residence *

Mailing Address (Please enter the address where pre-conference materials should be sent.) *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

State the reason you wish to attend the conference. *

(no more than 250 words total)

Explain how attendance will promote your practice in rural West Virginia. Give at least one example of how the conference agenda aligns with your goals as a health practitioner in West Virginia. *

(no more than 250 words total)

Are you a first time attendee? *

Scholarship Type: (check one) *

Mini Scholarship (Poster submissions only. Covers the night of November 14th. You must book/pay for your room, and WVRHA will reimburse when you arrive.)
Full Student In-Person Scholarship
Full In-Person Community Member
Virtual

Full and mini scholarships include lodging. The mini scholarship covers the night of November 14th. You must book and pay for your room, and WVRHA will reimburse when you arrive.

Have you submitted a poster abstract? *

Students - Upload Proof of Enrollment

Click or drag a file to this area to upload.

Are you willing to have your information shared with other speakers, attendees, and sponsors for networking within the conference platform? *

Our mission is to unite people, communities and organizations to strengthen rural health in West Virginia.

© West Virginia Rural Health Association 2025