Association of Surgical Technologists>


In addition to providing scholarship assistance to surgical technology students, The Foundation for Surgical Technology is also dedicated to helping practitioners (who are not educators), advance their education and provide assistance to individuals who volunteer for medical missionary work. A member is eligible to receive this award one time only.

Please fill out the application below and submit it to the Foundation at AST headquarters. The deadline is December 31, 2016.

Eligibility Requirements

  1. All applicants must be active AST members with currency.
  2. All applicants must provide a description of their membership history—join date and any AST involvement. Email supporting documentation to Be sure include your name and medical mission in the subject line.
  3. All applicants must provide official documentation of the educational program they are entering or the mission program they have described. Email to
  4. All educational programs must include an official course outline, program fees and transcript. All mission programs must includes official receipts documenting the costs incurred by the individual and all costs must be shown in dollars. All assistance is determined after the medical mission trip has occurred and the appropriate documentation has been provided. Email to
  5. Two letters of recommendation must be provided. Email to

List all educational/volunteer activities related to surgical technology:

Describe any AST positions held or board positions:

Please fill in the appropriate information that applies to your medical mission. Be as complete as possible in order to help the committee make the best possible decision. You are welcome to email brochures or any relevant material that will describe the program or mission you are proposing. Documentation of expenses must be valid receipts and any foreign currency expenses must be converted to dollars.

Mission Description

Mission Director/Dean

Goal of Mission

Level of support by mission

Amount requesting from Foundation

Letters of Recommendation


I agree that all the information above is correct and true.