TO: Hospital CEOs/Administrators
FROM: Sara Roberts, Kansas Department of Health and Environment
Chad Austin, Kansas Hospital Association
RE: Advanced Trauma Life Support (ATLS) Funding
DATE: March 15, 2011
We are happy to announce that the Kansas Rural Health Options Project is continuing its support for trauma education and the Advanced Trauma Life Support training to our rural health providers.
The Kansas Rural Health Options Project is providing 20 scholarships up to $1,000 for rural physicians to participate in the Advanced Trauma Life Support course. These scholarships will be provided to qualified applicants on need as well as on a first-come, first-serve basis. Early applications are encouraged with applications received by April 15, 2011 receiving higher priority. It is expected that the scholarships will be used prior to December 31, 2011.
Interested individuals should submit a formal letter of request that includes the physician’s name and email address, license number, course and hospital name along with the attached request form to Dan Leong, Director, Emergency Preparedness; Kansas Hospital Association; 215 SE 8th Avenue; Topeka KS 66603.
For further information contact Debbie Hall or Dan Leong at the KHA office, (785) 233-7436 or email@example.com. We strongly encourage Critical Access Hospitals to offer this great trauma training opportunity to their rural physicians.
ATLS Scholarship Request Form
Please complete the following information.
Credentials (check one)
ARNP PA DO MD
Provider Name: __________________________________________________
Provider Organization: ____________________________________________
Organization Mailing Address (city & zip): ______________________________
In which Regional Trauma Council area do you provide services? (Check all that apply)
NERTC NCRTC NWRTC
SERTC SCKTR SWRTC
ATLS Course Information
Please provide the following information for the ATLS class you plan to attend.
ATLS Course Location: ______________________________
ATLS Course Date: _________________________________
Registration cost: $___________
ATLS Scholarship Budget Summary
If you need additional funding, please list. Reimbursement will be at the state rate.
Note: If you are a recipient of the scholarship, you will be required to submit a certificate of completion.
Note: This application must be fully completed to receive a scholarship.