Scholarship Application

The National Alliance to End Homelessness has established a Scholarship Program to assist individuals who are currently, or have formerly experienced homelessness and cannot afford to cover the full cost of participating in the conference, or travel and hotel costs associated with the conference.

Scholarships Include:

·  Complimentary conference registration

·  Up to $400 roundtrip transportation to San Diego, CA to attend the conference

·  Hotel accommodations for two nights at the conference hotel during the conference

·  A stipend

Scholarships are not transferable to another individual and all applicants must be 18 years of age or older, or have a parent/guardian available to accompany them to the conference and cover the associated travel, hotel, and conference registration costs. Criteria for scholarship awards will be based on financial need, geographic distribution, and the leadership skills the applicant will be able to bring back to his/her community. The number of scholarships available will depend upon funding received for the Scholarship Program.

  1. In no more than 200 words, please describe what you would like to contribute to the National Conference on Ending Family Homelessness and what you expect to take back to your community:
  1. State briefly why you need financial assistance and how much you are requesting:
  1. Contact Information:

First Name: ______

Last Name: ______

Agency affiliation (if any): ______

Address 1:______

Address 2 (Apt #, Building, etc.): ______

City: ______State/Province: _____ Zip/Postal Code: ______

Country: ______

Phone number: ______Fax: ______

Email address: ______

Best Time and Method to Contact (for example: Monday at 3pm via phone): ______

4. Registration Information:

If granted a scholarship we will need additional information in order to register you for the conference. Please answer the following questions:

Name badge (please list your name as you would like it to appear on your name badge):

Do you require vegetarian meals?

No ____ Yes____

Please list any food allergies: ______

Pursuant to the Americans with Disabilities Act do you require specific aids or services?:

Audio____ Visual______Mobile____

Signature

By submitting this scholarship application, I am making a commitment to attend the National Conference on Ending Family and Youth Homelessness February 19-20, 2014.

______

Signature Date

1