Ned Etherington Annual Scholarship Application

About The Ned Etherington Scholarship

The Annual Ned Etherington Scholarship was created to recognize two deserving patients who have demonstrated a strong progress toward their treatment and significant financial hardship. Scholarship nominees must have been in treatment for a minimum of 1 year and be attending an OTPG member clinic. Scholarship recipients receive $500 to be applied toward clinic fees and their ongoing treatment.

If you would like to nominate a patient from your clinic for scholarship consideration, please complete the application below and click submit. The 2 winners will be announced at the OTPG Fall Conference.

Thank you for your submission.

ATTENTION: READ BEFORE COMPLETING APPLICATION

Before beginning this application, please be aware that patient privacy and confidentiality is of the utmost importance to Opioid Treatment Providers of Georgia.

DO NOT at any point in this application use any of the patient’s personally identifying information such as first and last name, date of birth, home address, or any other information that could compromise their privacy. Instead, use only the Patient’s ID number and their clinic name.
Is this clinic a member of Opioid Treatment Providers of Georgia?
Has this patient been in treatment for a minimum of 1 year?

Instructions: Please describe in detail why you believe this patient deserves to be considered for this scholarship.

What has this patient done during the course of their treatment that makes them stand out regarding their commitment to their own treatment and outlines the progress that they have made? What ongoing financial hardships does this patient face.

Be specific with your examples. Please outline anything else that makes you believe that this patient is deserving and can benefit from receiving $500 towards their continued treatment.

As a final reminder, please remember NOT to use any personally identifying information in this section. Only use the patient’s ID number when referencing them in order to protect their privacy.