Jewel Sexton Memorial Scholarship
Application for 2011Collaborations Conference.
Each Year VA-APSE dedicates a percentage of profits from the Annual Collaborations Conference to the VA-APSE Jewel Sexton Memorial Scholarship Fund. The fund’s purpose is to financially assist Virginians currently receiving supported employment servicesto attend VA-APSE sponsored training events. The conference will be held October 2-4 in Virginia Beach at the Wyndham Virginia Beach Oceanfront Hotel.
The purpose of the scholarship is for Supported Employees to attend the conference. In order tooffer the opportunity to as many people as possible to experience the conference, the scholarship will be awarded only to individuals that have not previously received one. Applications from previously sponsored persons will not be considered.
Send completed application and copy of conference registration form to:
Scott Fraley
VirginiaDepartment of Rehabilitative Services
8004 FranklinFarms Drive
Richmond,Virginia, 23229
or email at .
Questions? Call 804-662-7016
Scholarship awards will be disbursed as follows:
Conference registrationwill be sent directly to the conference registrar
Funds for lodging and transportation will be picked up by the scholarship award winner at theconference.
We request scholarship recipients join APSE,First year membership is complimentary
Applications for Virginia 2011 Collaborations Conference must be
received by 5:00 on September 2, 2011.
Name:Address:
City: / State: / VA / Zip Code:
Phone: / Email
Job Title:
Are you currently receiving SE services? / Yes / No
Name of SE provider
APSE Sponsored Training or Conference: / 2011 Collaborations Conference
Are you presenting at the conference? / Yes / No
Dates attending: / Sun – 10/2/10 / Mon - 10/3/10 / Tue – 10/4/10
Estimate expenses (itemize below). If traveling with personal care attendant/family assistant indicate additional lodging, if required.
Cost of conference or training event: / $220.00 Full Conference
APSE membership – Complimentary for 1 year / $0
Lodging (room rate $89 + Tax (13%) / # of nights / 1 or 2 / Circle # of nights needed
It is the responsibility of the award recipient to arrange lodging.
Will you have an attendant/assistant?
(Only if required by distance or disability related need.) / Yes / No
If Yes, will attendant/assistant require separate room? / Yes / No
Travel (if by personal vehicle) / # of Miles / X $0.50 =
Meals allowable meal expenses are:Monday Lunch @$13.00 $13.00
Meals included with registration are: Sunday – Evening Reception, Monday - Continental Breakfast & Awards Dinner, Tuesday - Continental Breakfast
Disability related expenses (itemize below):
Send completed application and copy of conference registration form to:
Scott Fraley
VirginiaDepartment of Rehabilitative Services
8004 FranklinFarms Drive
Richmond, Virginia, 23229
or email at .
Recipients will be notified by September 9, 2011