Sol Haberman Scholarship Award
Application

Name / Title:	(Ex: Joan Smith, MT (ASCP))
Mailing Address:
City:
State:
Zip:
Telephone:	(9am-5pm number, incl. area code)
E-mail:
Title of Paper:
Are You Willing or Able to Attend the Annual Meeting if Your Paper is Selected? Yes No
I do hereby submit that this entry is my own work. I may have received some guidance from an instructor or supervisor, but the plan is mine, and I alone have written the manuscript. I am now enrolled or was enrolled in the past year as a blood banking student, and request that this paper be reviewed by the Awards Committee for consideration of the Sol Haberman Scholarship. I, also, certify that this paper has not been previously published. Further, I hereby give my permission to have this paper reviewed by the editorial board for possible publication in the Journal, the official publication of the South Central Association of Blood Banks.
Date:
Signature:

TO BE COMPLETED BY EDUCATION COORDINATOR

Name / Title:
Institution:
Mailing Address:
City:
State:
Zip:
E-mail:
I do hereby certify that the above individual is currently enrolled, or was enrolled in the past year, at the above institution for the study of specialty in blood banking.
Date:
Signature:

IMPORTANT - PLEASE NOTE:

Please fill-out the form above. Before submitting this form, print a copy of the application page (a signed copy of the application must be faxed to 866-649-6590 or emailed to scabb@scabb.org).

After you Submit the form, you will be prompted to send a PDF version of your paper as described in the Sol Haberman Guidelines.

You will receive a confirmation email from scabb@scabb.org within 48 hours of receipt of your submission. If you do not receive this confirmation email, contact the Central Office at 866-649-6550.