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 non-physician 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 airfare expenses only.
- Supplies and Pharmaceuticals - exclusively available for physicians of Memorial Hermann Health System (see application).
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 Missions Scholarship Application
Memorial Hermann Medical Missions Supplies/Pharmaceuticals Application
Memorial Hermann Medical Missions Supplies/Equipment/Pharmaceuticals Donation Procurement Report Form
Post Mission Report Form for Medical Staff
Post Mission Report Form for Scholarships