PolkCountyPositive Behavior Support (PBS) Network

Scholarship Application Policy and Procedure

Purpose:

The Polk County Positive Behavior Support Network acknowledges the importance of continued education opportunities to our members. The PBS Network will support members by providing scholarship monies to assist in covering expenses to educational opportunities relevant to the Polk County Positive Behavior Support Network Mission, Vision, and Values.

Policy:

The Polk County Positive Behavior Support Network will follow a consistent procedure for distributing scholarship funds to members. One scholarship may be awarded per quarter per member agency. An agency cannot receive more than one scholarship per quarter.

Procedure:

1.)Applications will be received by the PBS Network Board President prior to the 1stFriday of the month.

2.)Applications will be reviewed by the PBS Network Board during their monthly meeting for approval.

3.)The applicant will be notified of the status of their application within 1 week after the completion of the Board meeting.

Responsible Party: PBS Network Board

Approved:PBS Network Board

Date Created: 4/2009

Review Date: 8/19/15

POSITIVE BEHAVIOR SUPPORT NETWORK

SCHOLARSHIP APPLICATION

Agency: ______

Name: ______

Address: ______

Phone: ______

Please attach the following to complete the application:

  1. A statement of 500 words or less describing why you are seeking participation in the identified training; and how your participation will support your growth professionally, including what you hope to contribute to the Positive Behavior Support Network through attending the training.
  2. Letter of support from an executive member at your agency.
  3. Complete the form: “PBS Financial Scholarship Worksheet.”

PBS Financial Scholarship Worksheet

This worksheet is intended to assist in finding out the total aid needed to ensure this is a successful event for your agency. Below should be totals for the whole event for every person going so the whole cost of the event will be known.

______

Registration Fee $______times number attending ______

Transportation (mileage, airfare, rental) ______

Lodging/Accommodations ______

Meals ______

Incidentals ______

Total ______

Please list any incidental expenses below:

______

______

______

______

Agency Break out: It is requested thateach agency pick up a percentage of each proposal. List below what the percentages would look like along with a total scholarship request.

Agency percentage ______= $______

PBS scholarship percentage ______= $______

Total requested $______

______

Applicant signatureDate

Board Decision: ______