Scholarship Application - Patient Family and LHON Sessions
June 25-26, 2021  -  Charlotte, NC
Submit this application form by April 18, 2021 (no payment required). Registration Information (once you receive an award notice by email or phone, UMDF will provide a registration code – no payment required with application):

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* Each person requesting a scholarship must complete and submit an application.

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* In order to attend the 2021 symposium, I need scholarship assistance for the following:

The Scholarship Award amounts for 2021 range from $100 to $500 per family and will be based on travel needs and availability.  Scholarship award amounts will not exceed $500.
Notewe have updated our policy regarding registration fees.

***Scholarship checks will be distributed upon completion of symposium – recipients must attend and complete a session voucher for at least three sessions per day to receive their scholarship funds.***
Requirements - you must be an affected adult and/or have an affected loved one to qualify for a scholarship.

UPDATED POLICY – If you have received a scholarship within the past three years (2017, 2018, 2019), you may not be eligible for TRAVEL/HOTEL assistance this year but you could qualify for REGISTRATION FEE assistance.
To help us determine needs, please answer the following questions - preference for travel/hotel assistance will be given to those who provide details.

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* Have you approached other organizations for support to help defray the cost of attending symposium?

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* Have you attempted to raise any money yourself toward your expenses?

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* Have you previously been awarded any funds by the UMDF?

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* If yes, what year did you receive funding (note - scholarships were not awarded in 2020 due to cancellation)?

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* Please provide a brief explanation of your financial situation; include any information that you feel is relevant including any volunteer involvement you have with UMDF and any extraneous expenses you will incur by attending.

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FAMILY REGISTRATION AND SCHOLARSHIPS SUPPORTED IN PART BY:

<div><strong><span style="font-size: 12pt; color: #000000;">FAMILY REGISTRATION AND SCHOLARSHIPS SUPPORTED IN PART BY:<br></span></strong></div>

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