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Scholarship Application Form

What Works, What Doesn't?
Community-Based Resaerch and Strategies for Change

June 11-13, 1999

To be considered as a scholarship recipient, this form must be completed and mailed by April 15, 1999 to:
SCHOLARSHIP APPLICATION

Name __________________________________________________________________
Organization __________________________________________________________
Mailing Address _______________________________________________________
City ________________ State _______ Zip __________ Country ____________
Phone ______________ Fax ______________ Email _________________________
Website _______________________________________________________________

I am applying for:

___ Full scholarship (travel expenses, room and board, registration)
___ Partial scholarship (please choose one or two of the following)

___ travel expenses
___ room and board
___ registration fee

1. What are your reasons for attending the conference? What are you hoping to learn?














2. Please explain your need for a scholarship.














3. What are your plans to bring what you learn at the conference back to your community or other networks?














4. Please include two names and telephone numbers of references who can speak to your work.














A SCHOLARSHIP WILL BE REWARDED ON THE BASIS OF ALL THE ABOVE INFORMATION.
SCHOLARSHIPS ARE LIMITED. YOU WILL BE NOTIFIED BY MAY 15th.

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Up 1999 conf main CRN Conf 1999 1999 Agenda CRN Evaluation Evaluation Registration Scholarship 1999 Report

 

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