Scholarship Application Form

To apply for the ABGERO scholarship please fill out and submit the form below. The application includes a brief form for describing applicants academic and work history. You are also asked to upload a brief essay (approximately 350 words) clearly addressing which scholarship category you are applying for, as well as your reasons for applying for the ABGERO scholarship.

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Applicant Contact Information

Name: *

First

Last

Email: *

Phone: *

Address: *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Academic and Work History

Please select which scholarship category you are applying to: *

Years licensed as a psychologist: *

Current Position/Title: *

Primary Work Setting: *

Academic Center
VA Medical Center
Other Medical Center
Private/Group Practice
Post acute care/rehab center
Consulting Firm
Other

If checked other, what is the primary work setting?

Do you work clinically with older adults and/or their family members? *

Primary work responsiblities: (Check all that apply) *

Direct patient care
Teaching
Training/clinical supervision
Clinical research
Administration
Other

If checked other, please let us know what that is:

Have you registered with ABPP? *

If yes, where are you in the board certification process? *

Please assign a percent of time dedicated to each checked so the total is 100%.

Direct Patient Care *

Teaching *

Training/Clinical Supervision *

Clinical Research *

Administration *

Other *

Information work Clinical

Additional information

Upload your essay: *

Drag & Drop Files, Choose Files to Upload

(PDF, DOC, DOCX or TXT format only, max size 10MB)

Optional message if you have a concern or question:

NOTE: If you don't receive confirmation of your entry from ABGERO within 2 business days, please reach out to aberoabpp@abgero.org.

Helpful Links

ABGERO Maintenance of Certification (MOC)
ABGERO Procedures Manual
Examination Manual for Specialty Board Certification in Geropsychology