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June 3 - 6, 2019, Worcester State University, Worcester, MA

Maine Department of Health & Human Services, Substance Abuse and Mental Health Services Scholarships

2019 New England School of Addiction Studies

The Maine DHHS Substance Abuse and Mental Health Services provides limited partial scholarship awards. Priority is given to those who have not received a state-funded scholarship in the past three years, and scholarships are distributed across as many agencies as possible.

Any remaining balance and travel are the responsibility of the participant. Scholarships are paid directly to AdCare Educational Institute. You, and/or your agency, are responsible for paying the remainder of program fees.

In addition to the partial scholarships, Maine SAMHS usually awards two special Maine full scholarships in memory of Maine people who contributed a great deal to the New England Summer Schools over the years. If you also wish to apply for the: Harold Miner Scholarship, or, if you work in medication assisted treatment, for the Paul McFarland scholarship, please provide brief narrative comments to the special questions requested at the end of the scholarship form.

Any remaining balance and travel are the responsibility of the participant. Scholarships are paid directly to AEI of New England. You, and/or your agency, are responsible for paying the remainder of program fees.

Deadline for scholarship applications has been extended to April 26, 2019.

Be sure to fill out the entire application. Incomplete applications will not be considered.

For scholarship related questions, please contact:

Theresa Witham
Department of Health & Human Services
Office of Substance Abuse & Mental Health Services
Theresa.Witham@maine.gov
207-287-4243

*Scholarship funds are limited. Filling out an application is not a guarantee of award.

Scholarship Application Instructions:

Please complete the form below to be considered for a scholarship from your state agency.

Required questions are noted with a star.

After you have completed the application, click on the "CLICK HERE TO SUBMIT SCHOLARSHIP APPLICATION" button at the bottom of the page.

Please note that a scholarship application is separate from your Summer School registration.

If you have not registered for the Summer School, visit www.neias.org

Contact Information

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* 1. First Name

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* 2. Last Name

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* 3. Email Address

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* 4. Alternate Email Address

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* 5. Employer

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* 6. Street Address

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* 7. City

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* 8. State (You MUST work or volunteer in ME to
apply for a ME scholarship):

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* 9. Zip Code

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* 10. Above address is a:

Work address

Home address

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* 11. Work Telephone

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* 12. Mobile Telephone

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* 13. Home Telephone (if not same as mobile phone)

About Your Job, Experience, and Professional Development

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* 14. Role - I am:

A professional working in alcohol and other drug (AOD) treatment services

A professional working in alcohol and other drug (AOD) prevention services

A professional working in mental health/co-occurring disorders treatment services

A professional working in alcohol and other drug (AOD) recovery support services

A state employee whose job requires knowledge of AOD services

A volunteer working in the AOD and recovery field

A representative of another profession or community with interest in learning more about AOD

A student enrolled in substance use disorder courses (Please specify major and college below.)

Other (Please specify below).

Please specify details about your role:

If you are a student, please specify university and major.

If you selected "Other" please describe your role.

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* 15. Title of Current Position

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* 16. Length of Time Working in Substance Use Disorder Field

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* 17. Length of time in current job

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* 18. Level of Education

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* 19. Licensures or Certifications:

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* 20. Primary Focus of Your Program

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* 21. Summer School courses I plan to take (List courses # and titles):

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* 22. Professional Development Goal # 1 and Objectives to Achieve Goal # 1

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* 23. Professional Development Goal # 2 and Objectives to Achieve Goal # 2

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* 24. Professional Development Goal # 3 and Objectives to Achieve Goal # 3

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* 25. Professional Development Goal # 4 and Objectives to Achieve Goal # 4

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* 26. Describe how attendance at the Summer School relates to the above goals and objectives.

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* 27. Will you:

Stay on campus

Commute

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* 28. If commuting, number of days you will attend:

Previous Summer School Attendance and Summer School Scholarships

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* 29. Years Attended Summer School:

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* 30. Have you received a Summer School scholarship in the last 5 years? Enter years, comma separated.

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* 31. If yes, please note the entity that awarded the scholarship.

Payment Planning

If selected, you will be responsible for ensuring payment of any remaining portion of your balance.

In many cases, partial scholarships are awarded .

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* 32. If selected:

If awarded a partial scholarship, I understand that I am responsible for any amount due by 6/3/19.

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* 33. Balance will be paid by:

My employer

My employer and me

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* 34. If you do not receive a scholarship:

My employer will pay for my registration.

I will pay for my registration.

My employer and I will pay for my registration.

I will withdraw my registration.

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* 35. Supervisor Information

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* 36. Supervisor's Name

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* 37. Supervisor's Email

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* 38. Supervisor's Telephone

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* 39. Additional Comments:

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* 40. Do you work in medication assisted treatment / recovery?

Yes, I work in medication assisted treatment / recovery.

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* 41. Special Maine Scholarships

In addition to the partial regular scholarships, Maine SAMHS usually awards two special Maine scholarship in memory of two Maine people who contributed a great deal to the New England Summer Schools over the years:
Paul MacFarland, who worked extensively on Maine's medication assisted treatment/recovery service system and New England Summer Schools; and
Harold Miner, who worked extensively on New England Summer programs and continuing education.
Please indicate if you wish to apply for these additional scholarships.

Paul MacFarland Scholarship - for those working medication assisted treatment / recovery

Harold Miner Scholarship

Both the Paul McFarland Scholarship and the Harold Miner Scholarship

Neither.

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* 1. First Name

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* 2. Last Name

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* 3. Email Address

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* 4. Alternate Email Address

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* 5. Employer

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* 6. Street Address

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* 7. City

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* 8. State (You MUST work or volunteer in ME to apply for a ME scholarship):

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* 9. Zip Code

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* 10. Above address is a:

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* 11. Work Telephone

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* 12. Mobile Telephone

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* 13. Home Telephone (if not same as mobile phone)

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* 14. Role - I am:

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* 15. Title of Current Position

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* 16. Length of Time Working in Substance Use Disorder Field

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* 17. Length of time in current job

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* 18. Level of Education

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* 19. Licensures or Certifications:

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* 20. Primary Focus of Your Program

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* 21. Summer School courses I plan to take (List courses # and titles):

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* 22. Professional Development Goal # 1 and Objectives to Achieve Goal # 1

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* 23. Professional Development Goal # 2 and Objectives to Achieve Goal # 2

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* 24. Professional Development Goal # 3 and Objectives to Achieve Goal # 3

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* 25. Professional Development Goal # 4 and Objectives to Achieve Goal # 4

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* 26. Describe how attendance at the Summer School relates to the above goals and objectives.

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* 27. Will you:

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* 28. If commuting, number of days you will attend:

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* 29. Years Attended Summer School:

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* 30. Have you received a Summer School scholarship in the last 5 years? Enter years, comma separated.

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* 31. If yes, please note the entity that awarded the scholarship.

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* 32. If selected:

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* 33. Balance will be paid by:

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* 34. If you do not receive a scholarship:

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* 35. Supervisor Information

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* 36. Supervisor's Name

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* 37. Supervisor's Email

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* 38. Supervisor's Telephone

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* 39. Additional Comments:

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* 40. Do you work in medication assisted treatment / recovery?

* 8. State (You MUST work or volunteer in ME to
apply for a ME scholarship):