Medical Missions Applications & Forms
Applications for Support
Funding is done in accordance with the availability of money. Applications are accepted for the following requests:
- Scholarships - for Memorial Hermann employees, support staff of Memorial Hermann medical staff physicians, and medical staff residents. Executive leadership and physicians are ineligible for travel scholarships. Scholarships apply toward air fare expenses only.
- Pharmaceuticals - exclusively available for physicians of Memorial Hermann Healthcare System (see application).
- Supplies - available for Memorial Hermann employees and Memorial Hermann medical staff physicians.
Applications are available from the Chaplaincy and Spiritual Care Office or as a downloadable file (see links below).
Select the appropriate form(s) below, print and fill out, then mail or fax to:
Memorial Hermann System Services
Division of Chaplaincy and Spiritual Care
909 Frostwood, Suite 1:607
Houston, Texas 77024
Acknowledgement, Consent, Agreement and Release from Liability (Collectively, "The Release")
Medical Mission Scholarship Application
Memorial Hermann Medical Missions Supplies/Pharmaceuticals Application
Memorial Hermann Medical Missions Supplies/Equipment/Pharmaceuticals Donation Procurement Report Form