CTANW & the 26th ADA Conference 2022
March 9-11, 2022
Otis Reed Memorial Scholarship Application
Name
*
First Name
Last Name
Organization
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Today's Date
*
What is your current title or job description?
*
How long have you been in this position?
*
What are your job duties?
*
Explain how your attendance at this ADA Conference will benefit your agency and your agency’s financial need.
*
I pledge to attend all Conference sessions and will report back to my organization(s)regarding information I receive. I understand that if I am awarded a scholarship and fail to meet my obligations of Conference attendance/participation that my employer or I will be billed by the Conference organizers for repayment of the scholarship amount.
*
Applications must be in by February 28, 2022.
Notifications will be make on or before March 8th.
Submit
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