4103 LSB, Provo, UT, 84602 Douglas Heiner Tel: (801) 422-3082 Fax: (801...

TheDouglasHeinerScholarshipismadeavailablefromthegenerousdonationsofDr.DouglasHeiner.Thepurposeistosupportstudentswhoareworkinginunderservedcommunitiesdoingmentoredresearchorfieldexperience.Examplesofsupportedinitiativesinclude:• Tuition• Travelassistanceformentoredresearch,fieldexperience,conferences,symposiaor

otherevents.

Eachproposalwillbeevaluatedonitsownmerit;however,itwillbereviewedwithinthecontextofothersubmittedproposals.Applicantsmustbefull-timestudentsintheMPHprogram.Preferenceisgiventostudentsfromlessdevelopedcountriesthatplantoreturntotheirhomecountrytostrengthenit.

Procedures1. CompletetheattachedDouglasHeinerScholarshipApplicationForm.Proposals

submittedinanyotherformatwillnotbeconsidered.

2. SubmittheDouglasHeinerScholarshipApplicationFormtotheMPHofficeoremailatmph@byu.edu.

3. Proposalsmaybefullyorpartiallyfundeddependentuponfundsavailable.

4. Fundswillbeusedfortheapprovedpurposeonlyasoutlinedintheproposal.Ifcircumstancesaresuchthatachangeisrequiredtotheproposalaftertheawardhasbeengranted,arequestshouldbesubmittedinhardcopytotheMPHoffice.

AvailableFundingOneormorescholarshipsmaybeawarded.Amaximumof$10,000willbedistributedcontingentonavailablefunds.

Douglas Heiner Scholarship

DEPARTMENT OF HEALTH SCIENCE 4103 LSB, Provo, UT, 84602 Tel: (801) 422-3082 Fax: (801) 422-0273 Web: http: //mph.byu.edu Email: mph@byu.edu

Name: StudentID: BYUContactAddress:

Phone: Email: CommitteeChair: IfrequestingtuitionassistancepleaseprovideaparagraphdescribingyourfinancialneedsorsituationandexplainhowyouwilluseyourMPHdegreetostrengthenunderservedpopulations.

AmountRequested:

Douglas Heiner Scholarship Application Form

DEPARTMENT OF HEALTH SCIENCE 4103 LSB, Provo, UT, 84602 Tel: (801) 422-3082 Fax: (801) 422-0273 Web: http: //mph.byu.edu Email: mph@byu.edu

Ifrequestingfieldormentoredresearchassistancepleasecompletethefollowingquestions:

Provideabriefparagraphsynopsisoftheproposedexperience.

Explainthedesiredoutcomeoftheproposedexperience(Purpose)

ExplainhowthisexperiencecorrelateswiththemissionoftheMPHprogram.

Describetheactivities,methodologies,etc.relatedtotheexperience.

Provideatimelineforthecompletionoftheexperience.

Listallothersourcesoffundingforwhichyouhaveappliedandthestatusofthoserequests.

Provideabudgetandlistbudgetitemsinpriorityorder,incaseonlypartialfundingisavailable.