DIA
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Patient Fellowship Application

DIA 2013 49th Annual Meeting
Advancing Therapeutic Innovation and Regulatory Science
June 23-27, 2013 | Boston, MA

Application Process

ELIGIBILITY

Candidates must:

  • Represent 501 (3) organizations in the United States or registered charities in Canada that serve constituents with major or rare/orphan diseases
  • Serve in a leadership role at a patient advocacy organization with executive, programmatic, policy or advocacy experience
  • Engage in, or be familiar with, activities related to biomedical research and/or drug development
  • Understand policy issues and the legislative process
  • Demonstrate proven track record around education and awareness activities

APPLICATION TIMELINE

Application Announcement: December 1, 2012
Application Deadline: February 1, 2013
Applicant Notification: March 15, 2013
Annual Meeting: June 23-27, 2013 (arrive Saturday June 22)

Application

GENERAL INFORMATION
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Section 2
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ORGANIZATION PRIORITIES
Which best describes your organizations funding priority? Choose one.



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CONSTITUENTS
Which best describes the constituents you serve? (choose one)

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INDIVIDUAL EXPERIENCE
Which best describes your skills and experience? (choose two)






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How did you first learn about the DIA Patient Advocate Fellowship Program? (check all that apply)




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SPEAKER REQUEST
If you are a patient in addition to being a representative of your organization are you willing to speak or be on a panel?

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ACCESSIBILITY REQUIREMENTS
Do you have specific accessibility requirements

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EURO MEETING APPLICANTS ONLY
I understand that English is the business language of the 25th Annual EuroMeeting 2013 I am confident of my ability to participate in the meeting.

I understand that I would be required to pay my own travel accommodations and other expenses.