Which HOD meeting Day(s) would you like to attend?
Are you being financially sponsored by your state society (through a formal mentorship program, scholarship program or contest)?
Do you wish to apply for the per diem of $40/day (max of $80 for both days)?
Please note: only non-sponsored student are eligible to apply for the per diem.
Where did you hear about the student mentorship program?
Are you interested in a continued mentorship program with members of the House of Delegates after the meeting (suggestions for mentorship could include: how to stay active in your state society, professionalism post-graduation, career path choices, etc.)?
What is your area of mentoring interest?
Examples: Neonatal/Pediatric, Adult Critical Care, Education, Long Term Care, Transport, Affiliate Leadership, other. This is designed to help you advance your knowledge
and skill set with someone from the House of Delegates that also has an interest or passion in this area.
1 - Why are you interested in attending the House of Delegates Meeting?
2 - Volunteer Experience - please list your involvement at your college/university and within your community. Please make special note of activities related to respiratory therapy.
3 - In what way would your state benefit from your being selected to attend the HOD meeting?
Once you submit your application, you and your program director will receive a copy of your application. If you do not
receive a copy of your application within 24 hours, it may not have been received. It is your responsibility to notify
us if you are having difficulty submitting your application. If you have questions about the application, please contact
one of the chairs via email: Julie Jackson or Cheryl Skinner.
Please Note: By applying to participate in the HOD student mentorship program you are agreeing to allow the student mentorship committee and/or your state affiliate
to contact you via email.