2019 SCD Centers Workshop Application Form
Questions marked with a * are required
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All applications for the 2019 SCD Centers Workshop must include the following:
  • Name and contact information for the person submitting the application. 
  • If applying as team, name and contact of team lead and list of team members (up to two) who would join the team lead at the workshop.
  • The application requires a biosketch using the NIH biosketch format. Please visit NIH Biographical Sketch.
  • A status document describing, in one to two pages, an overview of current efforts by the institution to serve the adult sickle cell disease patient population. Include in this document information on the size and characteristics of that population and a description of current efforts to serve this population. This document should provide insights into the needs of this patient population and might offer comments on the next steps that seem logical to address these needs.
  • Optional: The submission of a letter of support is highly desirable but not required. The purpose of the letter of support is to indicate that decision makers within the institution are generally supportive of efforts to address the needs of the adult sickle cell disease population served by the institution. The letter of support is highly desired, and its presence will be a positive factor in the weighing of applications. However, the letter of support is optional as some applicants will still be facing barriers to winning over such support. 
Please provide the name and contact information of the person submitting this application.
First Name
Last Name
Credentials
Title
Division
Department
Institution
Mailing Address
Telephone
Email Address
Please provide the name and contact information for the team lead for the application (if different from the submitter.)
First Name
Last Name
Credentials
Title
Division
Department
Institution
Mailing Address
Telephone
Email Address