We are so glad that you are interested in being part of the HEAL Summit 2017! The Summit will include a number of food-specific and COFPN-specific events and activities. To apply for a travel scholarship, please fill out the following application and we will respond to you after all applications are reviewed.

We will attempt to cover all requests, but depending upon the number of requests, we may offer partial scholarships. We encourage car-pooling! If you are planning on car-pooling and/or sharing a hotel room with a colleague, please coordinate with them before filling out this survey so only one person requests mileage and/or hotel.

Priority will be given to active members in the COFPN leadership council and work groups and to Summit speakers/presenters.

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* 1. Name (First and Last)

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* 2. Organization (if any)

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* 3. City

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* 4. Do you participate in:

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* 5. If you participate in a work group, which one/s? 

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* 6. Do you participate in a local/regional food coalition? If so, which one? (e.g., Jefferson County Food Policy Council)

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* 7. Are you speaking or presenting at the Summit? 

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* 8. What scholarships are you requesting? Click on all that apply.

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