Scholarship Application

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* 1. Contact Info

Name *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

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* 2. Please provide all relevant details regarding the training you are requesting scholarship for including the title, date, times, location, etc.

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* 3. Please share any follow up trainings required, long term commitments necessary, etc. that are a component of participating in or completing this training.

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* 4. Please provide the learning objectives for the training and detail how they relate to both your position and services you provide and the mission of the Firecracker Foundation.

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* 5. Please detail how this training will contribute to your overall professional development and your ability to provide services to childhood survivors of sexual assault.

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* 6. What is the amount of your scholarship request?

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* 7. If the amount you're requesting includes travel, lodging or other related expenses, please provide a detailed explanation of costs here.

If approved, you will be required to provide a signature acknowledging your agreement to attend the training and apply the lessons learned in service of the mission of The Firecracker Foundation. It is also required to have your supervisor's signature acknowledging this agreement and their understanding that, if you receive a scholarship for this training, and your organization does not fulfill their contracted obligations to the Firecracker Foundation we may ask that a pro-rated portion of the training fee be returned to the Foundation.

Once this application is completed, you will be contacted with a response within 30 days. If you have any questions or comments regarding your scholarship application, please call 517-242-5467 or send an email to info@thefirecrackerfoundation.org.