2018 David R. Cox Scholarship Submission
Medical School Name:
If other, please explain
Address Line 1
Address Line 2
Rare Disease Patient Community Addressed:
Approximate Date of First Contact
Family Caregiver of Patient
Nonfamily Caregiver of Patient
Method of Contact
Met in person
Voice or video call
Email or text
If Other, please explain
Did Global Genes match you with this rare family?
How did you hear about the Cox Scholarship?
Global Genes Website/Facebook
If other, please provide more detail
Upload Submission Document
By submitting this essay or audio recording, I affirm that I meet all listed requirements for consideration. This essay is my own original work, and I understand and consent that my essay or audio may be published under my name by Global Genes and/or Student Advocates for Neglected Diseases on their websites, through email, and in print. Materials provided for consideration are submitted by individual students for purposes of participation in the scholarship application only. Student Advocates for Neglected Diseases and Global Genes assume no responsibility or liability for the content of any of the materials submitted by participants in this contest.
All submissions must be compliant with the Health Insurance Portability and Accountability Act (HIPAA).* Authors must remove all HIPAA identifiers including unique patient characteristics prior to submission. For more information, please visit http://www.hhs.gov/ocr/privacy/. *Mandatory Requirement
Yes, I have removed all HIPAA identifiers, including patient characteristics, from my essay.
I am interested in being contacted about other leadership & advocacy opportunities in the rare disease community.
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