AHLA Hardship Fund Application

AHLA Hardship Fund Application

Thank you for your interest in maintaining your affiliation with or connection to AHLA. The Hardship Fund program provides financial assistance to health law professionals experiencing temporary financial difficulty who will benefit from access to AHLA's membership and educational resources and networking opportunities.

All applications are reviewed confidentially by AHLA staff. Please complete all sections of this form to help us understand your situation and needs.

Applicant Information

Personal Information

Full Name (First, Last):*

Email Address:*

Phone Number*

Phone

Street Address, City, State, Zip*

Current Employment Status:*

Select or enter value

Specify Employment Status:

Professional Information

Current Position/Title (if applicable):

Current Organization/Employer (if applicable):

Previous Organization/Employer (if applicable):

Years in Health Law Field:*

Practice Area(s) (list all):*

Requested Assistance

Please select the type(s) of assistance you are requesting

Select all that apply:*

Continuation of AHLA Membership for one year

Waiver of Conference Registration Fee (specify conference name and date)

Waiver of Registration Fee for Live Webinar (specify webinar name and date)

Specify Conference and/or Webinar (include dates)

Statement of Need

Please provide a brief statement (250-500 words) describing:

The nature of your current financial hardship
How AHLA membership and/or educational content would benefit your professional development at this time
Any additional information you believe would be helpful to consider

Use the space below to provide your statement:*

Additional Information

Please specify:

Certification and Submission

By submitting this application, I certify that:

The information provided is true and accurate to the best of my knowledge.
I am experiencing a temporary financial hardship that makes it difficult for me to afford AHLA membership and/or educational programming.
I understand that a hardship waiver is provided for one year of AHLA membership or registration for a single conference or live webinar.

Electronic Signature*

Date Submitted (MM/DD/YYYY)*

What Happens Next?

After submitting your application:

You will receive an email confirmation that your application has been received.
AHLA staff will review your application within 7 business days.
You will be notified of the decision via email.
If approved, you will receive instructions on how to access your membership benefits and/or register for the conference or live webinar.

Thank you for your interest in AHLA. We are committed to supporting health law professionals through all stages of their careers.

Questions? Contact khoggard@americanhealthlaw.org or call 202-833-0760.

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