Nomination Form

The Submissions are now closed. No further applications are being accepted. If you have any questions regarding the nomination form for a Robert Wood Johnson Foundation-sponsored grant or application process, please email Susanne Vellucci at Susanne@amia.org.

Grant assistance is offered to attendees of PHI 2011. In order to be considered for a grant, all form fields must be completed. Online submissions are strongly preferred.

AMIA will apply the following criteria to distribute 50 stipends of $1,000 each:

• Applicants must be a full-time employee of a public health organization at the local, city, state, federal, or territorial level.
• Applicants must register for PHI 2011 but may opt to do so at the early bird rate, which is no longer available online. To register at the lower early bird rate, please download the pdf form and fax (301-657-1296) or e-mail to dasha@amia.org (View the registration rates information.)

Submissions will be reviewed on a first-come, first-served basis. Awardees will be required to pick up a reimbursement package in Orlando in order to be reimbursed up to $1,000 for actual costs incurred, following PHI 2011. Receipts must be provided to AMIA.

Conference support provided by the Robert Wood Johnson Foundation.