PURPOSE: In order to further advance the mission of the Michigan Trauma Coalition (MTC), the MTC has chosen to offer a reimbursement for books plus shipping for a RTTDC course offered to a member level III or IV.

Reimbursements: The MTC reimbursement for RTTDC course books will be provided upon receipt of proof of the course and attendees. There is only one reimbursement for each member hospital provided the training.

AWARDS

• Reimbursement is distributed via check after all requirements are met.
• Applicant must provide a hospital mailing address and phone number.
• Based upon the availability of funds.

RTTDC Scholarship Application

Name(Required)

First Last

Email(Required)

Facility Name(Required)

Hospital Level(Required)

IIIIIIIV

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Daytime phone #

Mobile phone #

Facility training was provided for(Required)

Level of hospital trained(Required)

IIIIV

Date of Event(Required)

MM slash DD slash YYYY

Anticipated Attendance(Required)

Please fill out the Reimbursement Form. You will need to upload documentation of book costs and shipping (for verified attendees), attendee list, proof of course.

Signature(Required)

Phone

This field is for validation purposes and should be left unchanged.