Before You Apply
The online application takes about 15–20 minutes to complete. To help things go smoothly, please gather the following information and materials before you begin.
Note: the form does not save partial progress, so it is best to fill it out in one sitting.
Almost all fields in the application are required. Items marked (optional) below are the only exceptions.
Personal & Contact Information
- Your full name
- Phone number and email address
- Mailing address (street, city, state, ZIP)
Professional Background
- Your professional status (e.g. attending physician, resident, nurse)
- Your specialty area
- Years of experience in your field
- A brief description of any prior medical service experience
Employer or Residency Program
- Name and address of your employer or residency program
- Name of a contact person who can be reached for verification
Trip Details
- Travel destination(s)
- Departure and return dates (MM/DD/YYYY)
- A specific description of the medical services you will be providing
- Your medical service goals for the trip
- Information about any other grant funding you have applied for or received, including amounts
- Whether you will be traveling with a group, and if so, whether any group members will also be applying for funding from the Benjamin Josephson Fund
Sponsoring Organization
- Name and address of the organization sponsoring your work
- Name and phone or email of a contact person at the organization
Proposed Expenses
Estimated amounts in U.S. dollars:
- Air fare
- Ground transportation
- Housing
- Food
Additional Information
- How you heard about the Benjamin Josephson Fund (optional, but helpful)
Materials to Send by Email
The following materials are not part of the online form. Please email them to Diana.Valcarcel@atlantichealth.org:
- Your current CV
- A description of the sponsoring service organization
- If you are a resident in training: a letter from your program
director supporting your elective. The letter must:
- indicate that you will be receiving educational credit for the trip
- confirm that you will be supervised at all times
- confirm that the experience is part of your curriculum
Important Deadlines
- Your application, CV, and letter of support must be received at least 90 days before your planned departure date.
- If you are traveling with a group of three or more individuals to the same destination on the same dates, all completed applications must be submitted together for consideration.
- The Fund does not accept requests submitted after travel has already occurred.
After Your Trip
Reimbursement is contingent upon submitting the following materials within six weeks of your return:
- Original receipts for all expenses
- A 250-word synopsis of your experience
- Three to four photographs of you delivering direct medical care
Electronic submissions are preferred.
Questions before you start? Email Diana Valcarcel at Diana.Valcarcel@atlantichealth.org or call 908-522-2853.