IA2 Attendee Workshop Registration & Scholarship Application for National Indian Council on Aging Conference Survey

1.Contact Information(Required.)

Name

Organization

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

2.Tribal Affiliation (if any)

3.What workshops are you planning to attend? (Check all that apply)

NOTE: Savvy Caregiver for Indian Country Program Leader Training is now FULL.
(Required.)

Dementia Friends Champions Training - 4hrs Wednesday afternoon OR Thursday morning - for Staff or others interested in doing training sessions in your community

Native Caregiver Curriculum by the University of North Dakota - Sunday 9:00am - 5:00pm (limit 25 people)

Dementia Friends Information Session - 1hr Wednesday OR Thursday - for Elders, Caregivers and Community Members

4.Would you like to apply for a scholarship to attend Savvy Caregiver or Native Caregiver Curriculum Training?(Required.)

Yes

No

Scholarship Information

Scholarship funds are available for reimbursement of travel and registration expenses of up to $1,000 for individuals attending either the Native Caregiver Curriculum by UND or the Savvy Caregiver for Indian Country Program Leader Training.
Only one scholarship per person, per organization, and per tribal community will be awarded.
Scholarships are limited to available program funds and processed in the order in which applications are received.
Scholarships are transferable within your tribe or organization upon request and approval.
Scholarship funds are provided through a reimbursement process after the event unless there is a demonstrated hardship. Email maryann@iasquared.org for more information.
If funds are provided in advance and the recipient fails to attend the training, funds must be repaid.

Eligible applicants include:

Tribal, Urban Indian, or Indian Health Service:

Elder service providers and advocates
Social service providers
Public health providers
Health care professionals including Community Health Representatives

Applicants must attend either Savvy Caregiver for Indian Country Program Leader or Native Caregiver Curriculum Training. (Those only attending Dementia Friends Champions Training are NOT eligible for the scholarship.)

Ineligible applicants include:

Federal employees
Active Duty Military personnel
Students or individuals seeking degrees/certification/licensure
Individuals who do not provide services to elders
Consultants

IA2 Attendee Workshop Registration & Scholarship Application for National Indian Council on Aging Conference

Registration Page