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World Burn Congress Application

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World Burn Congress Application

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Phoenix Society's Readiness Guidelines
We hope that your experience at the World Burn Congress will be life-changing. Please read below some expectations we have of scholarship recipients to ensure the safety and well being of all attendees.
Scholarship Requirements:
- Applicants under 18 years of age at the time of the conference must be accompanied by a parent/guardian.
- Applicants must reside in San Diego or Imperial Counties and/or have been treated at UCSD Regional Burn Center in addition to being either a burn survivor, parent of a burn survivor, or a family member/caregiver that has had their life impacted by the burn or is involved in the recovery of the survivor.
- Funding priority is given to first-time attendees.
While at the Conference:
- Please plan on attending all four days of the conference and all conference sessions.
- Check-in with a Burn Institute representative when you are at the conference.
- Please behave appropriately at all times.
- Please provide the Burn Institute with a letter or email after World Burn Congress on how attendance at the conference was healing or beneficial.
- Scholarship recipients are invited to attend a communal meal with the Burn Institute and all scholarship recipients!
- Please note, you may incur some of your own costs while at the conference. Please plan accordingly!
1. Concider the following:
- you will be in the mix of a crowd of hundreds of burn survivors, family members, and care professionals, both formally (in sessions) and informally
- you will meet many new people whose experiences are both similar to your own healing, as well as unique to each individual
- you will hear other’s stories of struggles, strength, and thriving
2. Consider facing the following experiences with an open mind:
- be ready to be supported in your continued healing
- be ready to meet many new people - other attendees - looking to “connect with a smile”
- consider being open to talking to new people, one-on-one and in conference sessions
- be ready to listen to others’ survivor experiences, both one-on-one and in sessions
3. It is expected you have resources and/or ability to navigate around Phoenix World Burn Congress sessions, events, facilities, etc.:
- independently move (walk, wheel, etc.) to/from/around the hotel and conference center
- sit through sessions that may last an hour or more

Applicant Information
Applicant's Name
First Last
Primary Language Spoken
Please Indicate
- Burn Survivor
- Family Member
- Other
Other
Date of Birth
Month
Day
Year
Address
Street Address City State / Province / Region ZIP / Postal Code
Phone
Email
Emergency Contact
First Last
Emergency Contact Phone
Additional Applicant (1)
Please Indicate
- Burn Survivor
- Family Member
- Other
Other
Additional Applicant (2)
Please Indicate
- Burn Survivor
- Family Member
- Other
Other
Additional Applicant (3)
Please Indicate
- Burn Survivor
- Family Member
- Other
Other

Application
Have you previously attended World Burn Congress?
- Yes
- No
Have you previously received financial assistance from the Burn Institute to attend World Burn Congress?
- Yes
- No
List any family members who have previously received financial assistance from the Burn Institute to attend Phoenix Society's World Burn Congress (include name and year scholarship was received):
Are you able to attend the full conference? (Thursday - Saturday?)
- Yes
- No
I am applying for:
- Full scholarship (registration, lodging, travel, meals)
- Partial scholarship
If you are applying for the partial scholarship, what are you seeking a scholarship for?
If you are applying for the partial scholarship, how do you plan on paying for the rest of the conference costs?
Please help us learn more about your story, experiences, and reasoning for applying for this scholarship. Briefly answer the following questions in 5-10 sentences.
Tell us about you! You may choose to include information about date of burn, cause of burn, and where you are at in your recovery process. If you are a parent of a burn survivor or family member/caregiver, you may choose include information about the survivor as well as what role you have personally played in the survivor’s recovery process.
What do you hope to gain from World Burn Congress?
If there are additional applicants, what are you hoping they will gain from World Burn Congress?
Have you attended or volunteered for any Burn Institute events or programs? If so, what event, what year, and in what capacity did you participate?

Thank You!
We will be in touch soon about the status of your application! Please call us if you have any questions at 858-541-2277
Phone
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Our Mission is to educate and inspire communities to reduce burn injuries and empower those affected by burn trauma.

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Imperial Valley, CA

612 J Street, Suite 3
Imperial, CA 92251

P. (760) 355-3175

San Diego, CA

2508 Historic Decatur Rd., Suite 110
San Diego, CA 92106

P. (858) 541-2277

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