Family Enrichment Scholarship Application
The Kansas DeafBlind Project has a limited number of scholarships available for families of children with deafblindness to help supplement some of the costs for families to attend conferences, workshops, seminars, and trainings related to your child’s deafblindness. 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
2 digit month, 2 digit day, 4 digit year
Date
Parent #1 Name
*
First Name
Last Name
Parent #2 Name (if applicable)
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Name of Event (include website and registration link if available)
*
Start date of event
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
End date of event
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Number of family members attending
*
Please Select
1
2
3
4
5
6
7
8
9
10
Registration Cost
*
Total cost requesting for application
*
How are you planning on using the information gained from the event?
*
Submit
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