Travel Grant Scholarship Application

All fields are required.
Applicant Information
First Name: Last Name:
Institution:
Institution Mailing Address:
Daytime Phone Number:
Cell Phone:
Email Address:
Please select one of the following:
Medical Student, 2nd year
Medical Student, 3rd year
Medical Student, 4th year
General Surgery Resident, 1st year
General Surgery Resident, 2nd year
General Surgery Resident, 3rd year
General Surgery Resident, 4th year
General Surgery Resident, 5th year

Vascular Fellow, 1st year
Vascular Fellow, 2nd year
Vascular Surgery Resident, 1st year
Vascular Surgery Resident, 2nd year
Vascular Surgery Resident, 3rd year
Vascular Surgery Resident, 4th year
Vascular Surgery Resident, 5th year
Other:
Personal Statement
Please include a brief personal statement which summarizes your interest in vascular surgery and your goals for attending the EVS Annual Meeting. The statement should be limited to 1 typed page (double spaced, 12 point font).

Upload Personal Statement:
Nominated by:
Chief of Vascular Surgery
Chief of Surgery
Program Director
Department Chair
Other:

First Name: Last Name:
Institution:
Daytime Phone Number:
Email Address:
 

 
 
Eastern Vascular Society
500 Cummings Center, Suite 4400, Beverly, MA 01915
Phone: 978-927-8330 | Fax: 978-524-0498