Scholarship Application

Statewide Family Conference Scholarship Application

Parent Name(s): *
Address: *
City: *
Zip: *
Telephone Number:
Email:
Child’s name/age:
Hands & Voice of Oregon is committed to ensuring that ALL families can attend the Annual Statewide Family Conference. Hands & Voices of Oregon members will be given first priority, however, applications from all families will be considered. There are a limited amount of funds for parent scholarships therefore we are encouraging families to apply for partial scholarships. Payment arrangements are also available for the registration fee and hotel costs to assist families in “spreading out” the costs. Your contribution towards your Conference expenses will allow our scholarship funds to assist more families. Please check the expense for which you are requesting assistance. No scholarship application postmarked after April 30, 2010 will be considered. Registration fees ($25) $25 registration fee (includes all lunch, daycare, family of two). Hotel Room ($89 per night; one night only) One night family hotel room stay ($89). I understand that scholarship funds are not guaranteed, and that any amount I have agreed to contribute will be payable directly to the hotel for rooming charges or Hands & Voices of Oregon for the registration fee by May 12, 2010.
Electronic Signature:
Date: