Application

Khan Military Fund Award Program

Purpose: This program is intended to support Military trainees (medical students, residents, and fellows) with expenses associated with training while at UTHealth Houston.

Award: The Department is able to provide awards up to $1500 per award for continuing education travel, medical supplies, or books. Actual award amounts and continued funding is based on availability.

Awards are determined by a committee consisting of the Residency Director, Dr. Saleem Khan, and the ACS Division Director. The attached application is required. Applications will be considered on a rolling basis and distributed as funds allow each year.

Funding is not supplied directly to the trainee. Funding is maintained through UTHealth Houston and directly funds travel, books, or supplies.

Full Name:(Required)

First Last

Email Address:(Required)

Today's Date:

Training Level:

Military Status:

Active Duty

Reservist

Veteran

Amount Requested:

Military Career Background:

Please give us the background of your military career including the time and locations served

Have you previously received this award in a prior year?

Yes

If yes, please provide the amount awarded and how were the funds utilized:

Purpose of request or justification of new award request:

How will this award benefit UTHealth Houston?

Applicant Digital Signature Verification:(Required)

Type your full name