Participant Acknowledgement of Requirements (signature)
1. The information provided in this application is accurate
2. I must be a staff member at a UIO at the time of completion of my training or certification to receive reimbursement for expenses
3. My organization supports the training or certification requested
4. My organization is unable to completely underwrite the professional development activity for which I am requesting support
5. I agree to abide by all the requirements including providing appropriate post-event documentation (reimbursement form, evaluation form, post-event summary report, and proof of course/training completion).
I understand and agree that any false information, misrepresentation, or willful or negligent failure to disclose any information pertinent to this application or my organization will constitute sufficient grounds for removal of my application from consideration, the return of funding by me to NCUIH if funding has been granted, and or my disqualification from future scholarship opportunities.