We are now accepting scholarship applications for needs-based registration scholarships. We understand that there may be barriers to you attending Health Action, but we hope everyone who would like to will be able to attend our virtual event. Please submit your scholarship application by 11:59p.m. on Friday, November 27, 2020. Applicants will be notified of decisions during the first week of December.

If you have any questions about this application, please contact us at healthactionconference@familiesusa.org.

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* 1. First Name

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* 2. Last Name

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* 3. E-mail Address

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* 4. Phone Number

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* 5. Street Address

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* 6. City, State, Zip

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* 7. Organization
Which organization do you work for or represent?

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* 8. Role in Organization

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* 9. Your role at Health Action

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* 10. Have you attended Health Action in the past?

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* 11. Personal Statement
In 75-250 words, please explain the goals you wish to achieve by attending Health Action, why you would like to attend, and why you require assistance.

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* 12. Please provide a quote about the importance of the Health Action Conference to your work and advocacy.
Please note, Families USA may share your quote for promotional purposes on social media outlets. 

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