Stronger Together: Healing and Hope for Native American/ Alaskan Native Mothers and Families
TRAVEL SCHOLARSHIP APPLICATION

CONTACT INFORMATION

Thank you for your interest in Stronger Together: Healing and Hope for Native American/ Alaskan Native Mothers and Families

Tribal leaders, clinicians, community health, and supporters will convene October 12, 2018 at Portland State University to discuss the current landscape of available services and Native American /Alaskan Native women's and children's health outcomes. We will also identify opportunities for collaboration between tribes and urban Indian health organizations, highlight successful programs currently in practice, and identify areas of opportunity to replicate programs. Attendees will leave with ideas for next steps to optimize the health of all indigenous women, infants, and children.

Please complete this application to the best of your ability by Wednesday, August 15, 2018. While not all questions are required, the more complete the application is, the better the chances of scholarship award.

COMPLETING THIS SCHOLARSHIP APPLICATION IS NOT A GUARANTEE OF REGISTRATION OR ATTENDANCE AT THE HEALTH SUMMIT.

All applicants will be notified on or before Wednesday, August 22, 2018.

Click HERE for March of Dimes Privacy, Terms, and Notices.

Please address any questions to krivas@marchofdimes.org

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* 1. Your Contact Information

First and Last Name *

Job Title

Email Address *

Direct Phone Number *

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* 2. Where will you be traveling from?

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* 3. Will you require an overnight stay?

Yes, 1 night prior to the summit

Yes, 2 nights (night before/ night after)

No, just mileage/gas