IN Prevention Conference: Many Voices, One Vision Virtual Attendance Scholarship

Virtual Attendee Scholarship Application

The Division of Mental Health & Addiction is making 25 virtual attendee scholarships available for the 2022 Indiana Prevention Conference: Many Voices, One Vision.

Please complete the application for scholarship.

Scholarship applicants will be notified by Monday, September 26.

Question Title

* 1. Applicant Contact Information

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 2. Scholarship Applicant Work Experience.
Please share insights on your work in prevention.

Question Title

* 3. Scholarship Applicant Educational/Training Background.
Please include any Certifications, Licenses, and/or educational degrees held.

Question Title

* 4. Does the Scholarship Applicant have an active IC&RC recognized Certified Prevention Specialist (CPS) certification?

Yes

If yes, please identify number of years with a CPS

IN Prevention Conference: Many Voices, One Vision Virtual Attendance Scholarship

Virtual Attendee Scholarship Application

Question Title

* 1. Applicant Contact Information

Question Title

* 2. Scholarship Applicant Work Experience. Please share insights on your work in prevention.

Question Title

* 3. Scholarship Applicant Educational/Training Background. Please include any Certifications, Licenses, and/or educational degrees held.

Question Title

* 4. Does the Scholarship Applicant have an active IC&RC recognized Certified Prevention Specialist (CPS) certification?

Question Title

* 5. Why does the Scholarship Applicant want to attend the Indiana Prevention Conference: Many Voices, One Vision?

* 2. Scholarship Applicant Work Experience.
Please share insights on your work in prevention.

* 3. Scholarship Applicant Educational/Training Background.
Please include any Certifications, Licenses, and/or educational degrees held.