WV Mental Health Leadership Scholarship

This scholarship application is for funds to attend the Active Minds Conference in Washington, D.C. July 7-8, 2023

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* 1. Why do you want to attend the Active Minds Conference? Respond with 2-3 sentences.

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* 2. Are you an Active Minds Chapter member at your college?

Yes

Other (please specify)

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* 3. List other campus/student organizations you are a member of.

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* 4. List your leadership roles in campus/student organizations.

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* 5. For the 2023-2024 year I will be a...

Sophomore

Junior

Senior

Graduate student

Professional student

Community and technical college student

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* 6. If you are selected for a scholarship, how will you share the knowledge gained with your campus community?

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* 7. If you are selected for a scholarship, will you need lodging for the nights of July 6 and 7?

Yes, I will stay at the Capitol Hilton (conference location)

Yes, but I plan to stay at a different hotel

No, I plan to stay with family/friends in the Washington, D.C. area

Other (please specify)

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* 8. If selected for a scholarship, are you available to attend the entire conference? See link for agenda: Active Minds Conference Details

Yes

Other (please specify)

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* 9. Contact Info

Name

College

City/Town

State/Province

Email Address

Phone Number

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* 10. Provide the address of where you will be living in July. This location will be used to determine your travel allowance amount.

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Country *

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* 11. Age

Under 18

18-24

25-34

35-44

45-54

55-64

65+

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* 12. Do you understand that all scholarship funds must be used to attend the Active Minds Conference in Washington, D.C. in July 2023 and that any unused funds must be returned to the West Virginia Higher Education Policy Commission no later than July 15?