Health Profession Opportunity Grants (HPOG) Program Annual Grantee Meeting

OFA is asking each grant site to send the Project Director, along with two other staff members (may include partner organizations) to attend the HPOG Annual Grantee Meeting.

NOTE: Registration will be reviewed and approved by meeting organizers. You will receive a confirmation within three business days after date of submission as to whether your registration application has been approved.

Name Name First Middle Last
Job Title
Organization
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Telephone Telephone - ### - ### ####
Fax Fax - ### - ### ####
Email
Assistant's Name Assistant's Name First Last
Assistant's Email
ADA Requirements

This is the description of your section break.
Do you have any special needs (ADA requirements)?

Do you have any special needs (ADA requirements)? Yes No
If yes, please specify
Additional Information
Name of grantee organization that you are affiliated with (if different than above):
Photograph Confirmation

Photograph Confirmation By checking this box, I give permission to the United States Department of Health and Human Services and the Administration on Children and Families, to use my photograph/video, likeness, artwork, profile and/or story in all forms of media and all manners, including publications, web pages, video and other promotional materials. I understand the circulation of the materials could be worldwide and that there will be no compensation to me for this use. I waive any right to inspect or approve the finished product, including written copy that may be created in connection therewith.
Project Director

If you are Federal Staff please type "NA" in the Project Director box below and check the “Federal Staff” box in order to register
Name of Project Director Name of Project Director First Last
Project Director Confirmation

Project Director Confirmation By checking this box, you agree that you have confirmed your attendance with your Project Director before registering for this meeting. Federal Staff

Health Profession Opportunity Grants (HPOG) Program Annual Grantee Meeting

Health Profession Opportunity Grants (HPOG) Program Annual Grantee Meeting

ADA Requirements

Additional Information

Project Director