2012 AADE Foundation – Diabetes Health Pharmacist
Pharmacy Student Scholarship Application
Thank you for your interest in applying to the American Association of Diabetes Educators – Education and Research
Foundation’s Scholarship Program for 2012. Please read the entire application before completing it. Please do not hesitate to
call or email the Foundation with your questions or to clarify the application criteria.
Applicant must be a pharmacy student, in a PharmD program at an accredited university
Must be able to demonstrate an interest in the pharmacist role in diabetes education
Only electronically submitted applications using MSWord format will be accepted.
Completed applications must be submitted as an email attachment by 5:00 pm April 2, 2012 to email@example.com.
You will receive an email confirming your awards application by April 15. If you have not received a receipt email
confirmation by April 15, it is YOUR responsibility to contact AADE at firstname.lastname@example.org. You will be required to
forward your original email to confirm that it was sent by the April 2, deadline.
Scholarship will be awarded after May 15, 2012.
Resume/CV identifying pertinent education and work experience, extracurricular activities, professional organization
and research activities
Essay/letter explaining your interest in diabetes education, including what you hope to gain through attendance at
AADE Annual Meeting (1000 word maximum)
Three letters of reference – one must be from an instructor that can confirm student’s enrollment and academic
GENERAL APPLICANT INFORMATION
Last Name: First Name:
School Affiliation: Class level:
Phone Work: Home: Fax:
School Advisor Name and Phone:
By submitting an application and entering my name below, I understand and agree to abide by the entry and eligibility
requirements indicated. I understand that all materials submitted in conjunction with the award application will not be returned.
I agree that, if selected, highlights from the application may be used by AADE for such purposes as sharing best practices,
advertising, publicity, and promotion for or solicitation of future applications.
You will receive an email confirming your awards application by April 15, 2012. If you have not received a receipt email
confirmation by April 15, it is the applicant’s responsibility to contact AADE at email@example.com. You will be required to
forward your original email from your sent email archives to confirm that it was sent by the April 2, deadline.
(You may type name and date)
Questions? Contact Laura Roth Konopken at (312) 601-4863 or email firstname.lastname@example.org