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APPLY NOW

Application Deadline:  March 01, 2022

Personal Information

  • Please use your name as it appears on your Passport in filling out this application
  •  Please be sure you have an email that is working, you are checking regularly, and is easily able to identify you (no nicknames or letters that can confuse the Application Reviewer as to who you are in your email address). If needed create a new email that identifies you by your name.

Before Applying:

Be sure you meet all the criteria listed

  • An incomplete application will not be considered.
  • All Selected Applicants will have a virtual interview set up as the last part of being accepted into the International AFFIRM Program.

AFFIRM Applicant Criteria:

To be considered for this program, you must meet the following requirements: Which will include:

  • Males and Females
  • VWD type 3
  • VWD type 2 requires regular treatment or prophylaxis.
  • Glanzmann’s Thrombasthenia
  • Bernard-Soulier Syndrome
  • Other platelet function defects require regular treatment or prophylaxis.
  • Afibrinogenemia
  • Factors II, V, VII, VIII, IX, X, XI, and XIII requires regular treatment or prophylaxis.
  • Between the ages of 26 and 38 (no exceptions)
  • Access to factor for the duration of the conference.
  • No factor or infusion assistance will be provided for the duration of conference dates.
  • Proficient in written and spoken English (no exceptions)
  • Able to attend all program sessions
  • Able to travel unaccompanied and with appropriate visa and/or passport
  • Able to fulfill all aspects of the program criteria and understand what is being asked of you.
  • A letter of diagnosis from your medical team (physician or nurse) confirming your bleeding disorder diagnosis including severity.
  • A letter of support from your local foundation, chapter, or association. Acknowledging their support of you being in the AFFIRM Program
  • A letter of support from a person who can attest to your leadership abilities and be able to meet the goals and responsibilities of a leadership program. This
    person can be a teacher or professor, employer, etc. It cannot be a family member!
  • A personal essay describing your interest, qualifications, and reason why you should be selected to be in the International AFFIRM Program. A minimum of 500 words is expected.
  • Completion of the online application
  • To be considered for this program, you MUST meet all the criteria listed above!

SECTION 1: PERSONAL INFORMATION
SECTION 2: EMERGENCY CONTACT
SECTION 3: MEDICAL INFORMATION
SECTION 4: TRAVEL INFORMATION
SECTION 5: ADDITIONAL INFORMATION REQUIRED TO PROCESS YOUR APPLICATION
1. Upload Letter of reference
1. Upload File
2. A Letter of Diagnosis.
2. Upload File
3. Personal Essay
3. Upload File
4. Letter of support
4. Upload File
5. Headshot
5. Upload File
SECTION 6: RELEASE OF INFORMATION/LIKENESS AND CONTACT INFORMATION
SECTION 7: DISCLAIMER OF ACCEPTANCE
Applicant acceptance is at the sole discretion of the AFFIRM Selection Committee. The Committee consists of representatives from Global Blood Disorder Foundation Inc.,faculty, and colleagues in the bleeding disorder community. Bayer does not have a role in participant selection or program content.