HEROES Application

If you’d like to be considered for a Kisses from Katie HEROES grant, please fill out the form below and tell us why you’d be deserving of a grant up to $2,000 in value.

Our next deadline for applications is Friday, Decemer 15, 2017.  We are committed to providing a speedy response to applicants.  Grantees will be notified regarding the status of their application no later than December 29, 2017.

Good luck!  We encourage you to think outside the box!

Please click on the PDF link at the bottom to view the terms and conditions of receiving a grant.

Applicant Information 

Name: 
Email:   
Job Title: 
Hospital/Unit: 
       
Address:
 
City:
State:     Zip:
Phone:
       

Conference Information 

Conference Title: 
Conference Dates: 
Location: 

Estimated Expenses 

Registration: 
Hotel: 
Travel: 
Meals: 
       

Additional Information 

What other conferences have you attended in the last three years?  


   
How is this conference relevant to your work? 


  
Please explain how attending this conference will help you stay motivated and energized in your work with critically ill children.  


   


(Note: Required fields are bold)

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