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.
We are committed to providing a speedy response to applicants. Grantees will be notified regarding the status of their application no later than two weeks after receiving an application.
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 |
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| Name: | |
| Email: | |
| Job Title: | |
| Hospital/Unit: | |
| Address: | |
| City: | |
| State: | Zip: |
| Phone: | |
Conference Information |
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| Conference Title: | |
| Conference Dates: | |
| Location: | |
Estimated Expenses |
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| Registration: | |
| Hotel: | |
| Travel: | |
| Meals: | |
Additional Information |
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| What other conferences have you attended in the last three years? |
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| How is this conference relevant to your work? |
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| Please explain how attending this conference will help you stay motivated and energized in your work with critically ill children. |
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(Note: Required fields are bold) |
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