SUBMISSION DEADLINE: 5pm MST Monday April 12, 2021

The scholarship application for the 2021 In-person/Virtual CCI Spring Training Conference is now open. Scholarships will cover mileage and hotel stays based on the information provided. All applications must be submitted online and are due no later than 5pm MST Monday April 12, 2021 and must be fully completed in order to be considered.

For any questions, email Chloe Aponte at chloeaponte.CCI@gmail.com.

IMPORTANT RULES TO READ:
-All submitters will be notified by email to the addresses provided on the application form.
-Scholarship recipients must attend the entirety of the Conference (Monday 5/3 & Tuesday 5/4 from 9am-5pm MST).

Notifications will be emailed out on Tuesday April 13, 2021. 

Question Title

* 1. Applicant First, Last Name

Question Title

* 2. Applicant Job Title

Question Title

* 3. Applicant Coalition or Organization Name

Question Title

* 4. Applicant Address

Question Title

* 5. Applicant Public Health District *see map below*

Question Title

* 6. Idaho Public Health District Map

Question Title

* 7. Applicant Phone Number

Question Title

* 8. Applicant Email Address

Question Title

* 9. Are you over the age of 18?

Question Title

* 10. Are you (your organization/coalition) a paid CCI member?

Question Title

* 11. If not, would you be interested in receiving the Membership information that would introduce you to the benefits of being a paid CCI member?

Question Title

* 12. Please indicate your request (check all that apply)

Question Title

* 13. Please indicate if you plan to attend with a coworker and if you are willing to drive/lodge together for this training Conference. If yes, please provide their name and email address as well. 

T