Jachin Misko Memorial Scholarship Nomination Form

To nominate an individual for the Scholarship, please complete the form below. Only one nomination per eye bank will be accepted. The nomination deadline is November 10.

"*" indicates required fields

Nominee's Information

Nominee Name:*

First Last

Job Title:*

Eye Bank:*

Phone:*

Email:*

Nominated By:*

How long has this individual been involved with the eye bank?:*

Why should this individual receive the Jachin Misko Memorial Scholarship for Technical Advancement in Eye Banking? (50-100 words):*

How will this person benefit from attending the EBAA Technician Education Seminar? (50-100 words):*

How has this individual helped to drive innovation in your eye bank? (50-100 words):*

Describe how this individual has demonstrated leadership skills within your eye bank (50-100 words):*

What are your expectations about this individual's future career in and contributions to eye banking? This can include work at the eye bank and the association. (50-100 words):*

Nominee's Personal Statement

Please include a statement by the candidate stating personal objectives for the seminar and the reason(s) he/she would benefit from attending the seminar.

Personal Statement*

Accepted file types: word, pdf, doc, docx, , Max. file size: 25 MB.

Nominee's Headshot

If available, please submit a headshot of the nominee.

Headshot*

Accepted file types: jpg, pdf, png, Max. file size: 25 MB.

Nominee's Information

Nominee's Personal Statement

Nominee's Headshot

Connect

Tools

Our Sites

In Partnership