Scholarship Application

Partners for Change: Conference on Domestic & Sexual Violence and Stalking

September 24-25, 2014

A limited number of scholarships are being offered for attendance at the 2014 Partners for Change Conference in Norman, OK, September 24-25, 2014. Funds are available to pay for conference registration, hotel, meal per diem and mileage for victim advocates, law enforcement and prosecutors. The hotel and conference fees will be directly billed to the Office of Attorney General and recipients will not be responsible for those upfront costs, however recipients will be required to provide credit card information to the hotel for incidentals. Recipients will be responsible for their mileage and meals but will be reimbursed for these costs after reimbursement documentation has been submitted and approved. In order to be eligible for reimbursement all documentation must be received within 30 days after the conference. The process for reimbursement will be outlined for those applicants who receive approval.

Important Information:

  • This form allows you to apply for scholarship funds to cover registration, travel, lodging, and/or meal per diem.
  • Scholarships are not transferable. Scholarship recipients must notify the Office of Attorney General if they cannot attend.
  • Completed applications should be returned via fax or email no later than August 4, 2014.
  • Scholarships will be announced via email on or before August 18, 2014.
  • Instructions for online registration and lodging will be forwarded after scholarship approval.
  • Reimbursement forms must be received by October 25, 2014. No late reimbursement forms will be accepted.
  • Mileage and per diem will be reimbursed in accordance with the State Travel Reimbursement Act.
  • Any costs exceeding the approved amount will be the responsibility of the recipient.

Scholarship Application

2014 Partners for Change Conference on Domestic & Sexual Violence and Stalking

September 24-25, 2014

Embassy Suites Hotel & Conference Center

Norman, OK

Send completed application to:

Fara Coffey

405-557-1770 (fax)

Deadline: August 4, 2014

Applicant Name:______

Agency Name:______Job Title:______

Mailing Address:______

City/State/Zip:______

Phone:______Fax:______

(area code)(area code)

Check Discipline:

Advocate*Law EnforcementProsecutor

Check Agency Type:

_____Local or State Government Agency ______

(Type of Agency)

_____Non-Profit Agency______

(Type of Agency)

_____Other______

(Type of Agency)

I work directly with victims of domestic/sexual violence as part of my job. Yes_____ No_____

*Advocates must work at a certified DV/SA program, tribal DV/SA program, prosecutor’s office, or law enforcement agency

Please indicate below the type of scholarship you are seeking:

Registration:_____Lodging:_____Per Diem:_____

Mileage: From______(city) to Embassy Suites Hotel & Conference Center.

**NOTE** Due to state travel regulations, you must live at least 60 miles from the hotel site to be eligible for lodging and per diem. Per Diem is calculated according to Oklahoma State Travel Regulations.

Please write a brief narrative expressingwhy you would like to attend this conference:______

______

Have you previously attended this conference? ______

If so, how many times? _____When was the last year you attended? ______

Please direct questions to:

(advocates)

(prosecutors)

(law enforcement)

All applicants must sign the following:

I understand that by accepting a scholarship, if one is granted to me, that I am accepting federal funds given on my behalf to attend the conference. I understand that I am required to attend all sessions of the conference. If I do not attend the sessions while at conference I understand that I am responsible to pay back any and all scholarship funds given to me.

______

ApplicantDate

Supervisor’s Statement of Support

2014 Partnership Conference

On Domestic & Sexual Violence and Stalking

September 24-25, 2014

Embassy Suites Hotel & Conference Center

Norman, OK

Deadline: August 4, 2014

I have reviewed the scholarship application prepared by______. I concur in its submission and the applicant has my support in attending the conference.

I further state that there are no departmental/agency funds available for this applicant to attend the conference without being awarded the scholarship support.

Supervisor’s Signature______

Supervisor’s Typed or Printed Name______

Agency Name:______Title:______

Mailing Address:______

City/State/Zip:______

Phone:______Fax:______

Email:______

Please return to:

Fara Coffey

Victim Services Unit

Office of Attorney General

313 NE 21st Street

Oklahoma City, OK 73105

Fax: (405) 557-1770

Email:

Applications will only be accepted July 14th through August 4th. Those submitted before or after will not be considered.