SCHOLARSHIP - Family Enrichment Scholarship Application

Family Enrichment Scholarship Application

The Kansas Deaf-Blind Project has a limited number of scholarships available for families of children with deaf-blindness to help supplement some of the registration costs for families to attend conferences, workshops, seminars, and trainings related to your child’s deaf-blindness. The Family Enrichment Scholarship is offered on a first come, first served basis, as funding is available. The scholarship is through a reimbursement process. You will be required to submit the receipt and complete a W9 for our business office.
Child's Name

First Name Last Name
Child's Date of Birth

Month Day Year
Date
Parent(s) name *

Prefix First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *

Area Code Phone Number
E-mail *
Is this the first time applying for the Family Scholarship?

Yes No
If yes, what year?
Name of Event; include website, if available.
Date of Event

Month Day Year
Date
Registration Cost
Lodging cost
Conference Cost Requested
Number of Family members attending?
Why do you want to attend the event?
How are you planning to use the information gained from the event?
Should be Empty: