Scholarship Request Form

If your attendance at the Global Digital Health Forum is dependent upon receiving travel support, please feel free to apply for a travel scholarship.


Deadline for submission is August 18, 2019.


Please contact us at globaldigitalhealthforum@gmail.com with any questions.



First Name*
Last Name*
Company/Organization*
Role*
Country
Email*
On successful registration, the system will send a temporary password to your email address which you can later change from your dashboard
What kind of financial assistance do you require to attend the Global Digital Health Forum?*



What is the name of your presentation at the 2019 Global Digital Health Forum?*(Up to 100 Words)
Please tell us in detail about digital health activities associated with your current job.*(Up to 100 Words)
Please explain why you should be considered for a scholarship to attend the Global Digital Health Forum?*(Up to 100 Words)
Please explain how the 2019 Global Digital Health Forum would benefit from your participation?*(Up to 100 Words)
Have you attended the past forums (either the mHealth Forum or Global Digital Health Forum)?*(Up to 100 Words)
Have you attended any ICT4D or other Digital Health Conferences in the past year? If so, which ones?*(Up to 100 Words)
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