2019 Polly Vincent DiCesare Scholarship Application Survey

Scholarship Eligibility: Directors of Social Work and social work professionals from a LeadingAge New York member facility. New directors of social services or social workers not holding a director position are strongly urged to apply. If desired, you may type your responses in Microsoft Word and copy and paste into this online form when you are ready. Questions marked with an asterisk are required.

Upon applying you are agreeing to attend the WHOLE conference.

For more information on the scholarship, visit our website: https://www.leadingageny.org/leading-u/2019-conferences/nursing-social-work-professionals-annual-conference/polly-vincent-dicesare-scholarship/

1.Please enter the information indicated below:(Required.)

Name:

Job Title:

Company Name:

Email Address:

Phone Number:

2.How long have you been a social work professional?(Required.)

3.Are any other social workers from your organization attending the conference?(Required.)

Yes

Unsure

4.Have you ever attended this conference in the past?(Required.)

Yes

5.If yes, how many times and when did you last attend?

6.Please list the sessions at the conference that are of particular interest to you and explain why.(Required.)

7.How would you use the knowledge you gain from your attendance at the conference to enhance the quality of life of the residents you serve?(Required.)

8.Is there any other information you would like the committee to consider in evaluating your application?

In submitting this application, I acknowledge that I will attend the full conference if awarded the scholarship. If necessary, I have received the authorization from my organization to attend.

After submitting this application, please email a current resume to Cathy Bongermino at cbongermino@leadingageny.org. If you need to provide additional information that could not fit on this form, please email cbongermino@leadingageny.org. Click the "DONE" button below to submit your application. Thank you!

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