Fall 2025 Faculty Development Scholarship Pilot
Contact Information
Full Name
Gender
Male
Female
Non Binary/3rd Gender
Prefer not to say
Email Address
What is your discipline? (Select one)
Please select...
Physician
Nurse Practitioner
Registered Nurse
Chaplain
Social Worker
Physician Assistant
Other
What is your primary specialty/or practice area? i.e. Palliative Care, Pediatrics etc.
What is the name of your primary institution or employer?
Please specify other discipline
Country of Residence
Eligibility
How do you plan to use the VitalTalk Faculty Development training in your work or educational setting?
Please describe why receiving a scholarship would increase your access to faculty development including any funding limitations without scholarship support.
Do you work in a safety-net hospital or primarily with underserved patient populations?
Yes
No
Not sure
If Yes, please briefly describe your work setting:
Do you identify as a member of a group that is underrepresented in healthcare or academia? (Optional)
Black or African American
Hispanic or Latinx
Native American or Alaska Native
Native Hawaiian or Other Pacific Islander
Asian
Middle Eastern or North African
LGBTQ+
Person with a disability
First-generation college graduate
Other (please specify)
Prefer not to say
Please specify (if 'Other' selected above):
Availability
Please indicate all the course cohorts you are available to attend. Notes spots are very limited in each. You may select multiple dates if you have flexible availability. :
R1 September 10-12, 2025; R2 December 3-5, 2025
R1 October 22-24, 2025; R2 January 28-30, 2026
R1 November 19-21, 2025; R2 April 8-10, 2026
I understand that as a scholarship recipient I would receive 40% of the total cost of Faculty Development. I would be responsible for the remaining tuition of $3594.
I confirm
I have taken, or plan to take, the Faculty Development Pre-requisite (Mastering Tough Conversations course or a Powered by VitalTalk course offered at home institutions):
Yes
No
Not sure
Contact Information