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THSNA Mentoring Award Competition 2024
Award Guidelines
Please view the award guidelines
here.
Mentee Information
First Name
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Last Name
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Affiliation
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Email Address
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City
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State
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Please indicate the THSNA member organization(s) you belong to.
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American Thrombosis and Hemostasis Network (ATHN)
Anticoagulation Forum (AC FORUM)
Association of Hemophilia Clinic Directors of Canada (AHCDC)
Canadian Pediatric Thrombosis and Hemostasis Networks (CPTHN)
The Hemophilia Alliance (HA)
Hemostasis and Thrombosis Research Society (HTRS)
International Society for Laboratory Hematology (ISLH)
National Blood Clot Alliance (NBCA)
National Hemophilia Foundation (NHF)
North American Specialized Coagulation Laboratory Association (NASCOLA)
Platelet Disorder Support Association (PDSA)
Mexican Society of Thrombosis and Hemostasis (SOMETH)
Thrombosis Canada (TC)
None of the Above
I am committed to the field(s) of:
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Hemostasis
Thrombosis
Hemostasis & Thrombosis
Please indicate your level of training.
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I am within 7 years of completion of all formal training
I am beyond 7 years of completion of all formal training, but seeking to learn a new skill.
Comments
Which category you align with.
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Nursing
Laboratory technologist/specialist
Pharmacist
PhD researcher
Physician investigator, clinical, translational, or basic
Patient advocate
Mentor Information
Mentor's First and Last Name:
*
Mentor's Affiliation:
*
Please indicate the THSNA member organization(s) the proposed mentor belongs to.
*
American Thrombosis and Hemostasis Network (ATHN)
Anticoagulation Forum (AC FORUM)
Association of Hemophilia Clinic Directors of Canada (AHCDC)
Canadian Pediatric Thrombosis and Hemostasis Networks (CPTHN)
The Hemophilia Alliance (HA)
Hemostasis and Thrombosis Research Society (HTRS)
International Society for Laboratory Hematology (ISLH)
National Blood Clot Alliance (NBCA)
National Hemophilia Foundation (NHF)
North American Specialized Coagulation Laboratory Association (NASCOLA)
Platelet Disorder Support Association (PDSA)
Mexican Society of Thrombosis and Hemostasis (SOMETH)
Thrombosis Canada (TC)
None of the Above
Program Information
Please indicate below the city, state, and country to which you will travel to and from if awarded.
Traveling from:
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Traveling to:
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Please indicate the calendar week that you propose to begin work with the mentor.
*
+
Please indicate the calendar week that you propose to end work with the mentor.
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+
Please upload your CV.
Please upload as a PDF or Word Doc.
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Please upload a letter of support from your institution, written by your local division chief, section head, direct manager or supervisor, or program director.
Please upload as a PDF or Word Doc.
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Please upload the letter of commitment from your mentor.
Please upload as a PDF or Word Doc.
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Please upload a short essay outlining the 3 items below:
a short essay outlining what the mentee expects to learn or obtain from the mentorship experience and their career background
applicant background narrative, including personal and/or career goals relevant to hemostasis and thrombosis
an explanation how this experience may contribute to future success and career development in the field of thrombosis and hemostasis
a general description/timeline of activities to be planned for that week and any subsequent collaborations/mentorship activities that will follow.
Please upload as a PDF or Word Doc. This document should be double spaced and 5-pages maximum in length.
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Please upload at least 1 letter of reference. Note, if you are submitting more than one letter, please combine the letters into one file.
Please upload as a PDF or Word Doc.
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Please upload a proposed travel budget.
Please upload as a PDF.
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Any additional information