VBCOA Mid Year Conference Scholarship Form Scholarship Application Form 2021 VBCOA Mid Year Conference March 22-23, 2021 Virtual Conference (Eventmobi) Questions? Please contact Mike Williams mike.williams@harrisonburgva.gov Patrick Hughes phughes@cityofchesapeake.net OK Question Title * 1. Date of Application Date / Time Date OK Question Title * 2. Applicant Information Name Jurisdiction Region Job Title Email Address Phone Number OK Question Title * 3. Are you a current VBCOA Member in good Standing Yes No OK Question Title * 4. Are you a first time attendee for a VBCOA Conference? Yes No OK Question Title * 5. Have you ever received a Scholarship from VBCOA? Yes No OK Question Title * 6. Are you a current VBCOA Committee Chair or Committee Member Yes No If yes, name of Committee OK Question Title * 7. How will you benefit from this scholarship? OK Question Title * 8. Do you have the approval of your Building Official or Supervisor to attend this virtual conference Yes No OK DONE