EuroJAM scholarship application form

The IgG4ward! EuroJAM Scholarship Program brings hope, support, and education to those living with IgG4-RD and members of the greater IgG4-RD community. We are committed to making the IgG4ward! EuroJAM accessible to as many individuals and families as possible. If financial circumstances make attending difficult, we encourage you to apply for support. All applications are reviewed with care and confidentiality.

*Required

Section 1 – Applicant Information

First Name *

Date of Birth *

Last Name *

Address line 1 *

City

ZIP / Postal Code

Address line 2

State / Province / Region

Country *

Phone *

Email *

Section 2 – Diagnosis Information (if applicable): Complete this section if you have received an IgG4-RD diagnosis.

Complete this section if you have received an IgG4-RD diagnosis.

Date of IgG4-RD Diagnosis

Treating Physician's/Clinic Name

Section 3 – Scholarship History

Have you previously received a scholarship from IgG4ward! for a JAM event?

Yes

Section 4 – Scholarship Request

rich text

To help meet different levels of financial need, we offer three scholarship options: £100 – Partial Scholarship For those who can contribute but need some assistance. £250 – Half Scholarship For those who require more substantial support to attend. £400 – Full Scholarship For those who would otherwise be unable to participate without full assistance. Please select the level that best reflects your current situation.

Section 5 - Personal Statement

Summary

Please explain why you are applying for this scholarship and how attending the IgG4ward! EuroJAM would benefit you. You may include how IgG4-RD has affected you or your family, financial considerations, what you hope to learn, and why connecting with others matters to you.

Personal Statement *

Agreement *

I certify that all the information provided in this application is true and accurate to the best of my knowledge. I understand that providing false information may result in the revocation of any scholarship awarded.

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EuroJAM scholarship application form