2019 VFN Annual Conference - Scholarship Request Form

2019 VFN Annual Conference Scholarship Request Form

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* 1. Personal Information

Name *

Address *

Address 2

City/Town *

State *

ZIP Code *

Email Address *

Phone Number *

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* 2. Are you a parent or guardian of a child (of any age) with special needs?

Yes

No, but I am a family member of a child (of any age) with special needs.

Other (please specify)

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* 3. If "yes", how old is your child?

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* 4. Are you a refugee, immigrant, or other New American?

Yes

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* 5. Why do you feel it is important for you to attend this conference?

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* 6. How much aid would you need in order to be able to attend our conference?

Could you consider paying $55 (a $20 scholarship) as this covers your meals for the day? We want you to attend without it being a financial burden, so please pay only what you are able to.

Please note that our scholarship funds are limited, so the further we are able to stretch them, the more families are able to attend this educational and networking opportunity.

We are asking families who are recipients of scholarships to please consider writing a testimonial for the conference. Once the conference is over we will email you and ask that you send us a statement that we can use in future marketing.

$56.25 scholarship - I can afford to pay $18.75.

$37.50 scholarship - I can afford to pay $37.50.

$18.75 scholarship - I can afford to pay $56.25.

Full $75 scholarship - I cannot afford to pay anything.

Other (please specify)

Please do not register for the conference at this time. Once approved, you will be contacted by a VFN staff member with a code that will allow you to register at a reduced rate. Thank you so much! Please feel free to contact Claire at claire.giroux-williams@vtfn.org or 802-876-5315, ext. 201 with any questions.