2024 Legacy Scholarship Application

The Susan Vaughn

Legacy Scholarship Award

Application:

Please complete the form below to apply for the Legacy Scholarship. Email hcushen@nashia.org with any questions.

Full Name:*

First NameLast Name

Agency/Organization/School/Other:*

Current Title/Position:

Current Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Email Address:*

example@example.com

Phone Number:*

NASHIA Membership Status:*

Please confirm the in-person conference events you can attend?*

Pre-Conference on Home and Community Based Services (Sept. 16)Main Conference (Sept. 17 - 19)Both Pre-Conference (Sept. 16) and Main Conference

Upload resume or vitae. File type accepted: pdf, docx, jpg, png.*

Please describe the work you are currently involved with in your state in any or all of the following areas: state level systems, partnerships, public policy, advocacy, service provision, education, awareness. (500 words max)*

0/500

Please describe how you anticipate attending the SOS Conference will enhance your work as it relates to any or all of the following: agency/organization, community, policy work, professional development, partner community. (500 words max)*

0/500

Please describe your contributions, if any, to your community, state, or associations such as NASHIA within the past 2 to 3 years. *This does not have to be related to the field of brain injury. (500 words max)*

0/500

Please provide a statement regarding your financial need for this Legacy Scholarship. (500 words max)*

0/500

Please include other information that you would like the Legacy Scholarship Review Committee to know as it relates to the application for this registration scholarship. (500 words max)

0/500

Please read the following statements and initial for acknowledgement:

Legacy Scholarship Rules:

The scholarship awarded may cover the in-person pre-conference registration fees and/or the in-person main conference registration fees. (max. value of $900). Meals included in the registration fee will be included. *Please note that the scholarship award does not cover travel, lodging, meals not included in the registration fee, and/or incidental expenses.
Applications must be completed online and submitted by the deadline date - Monday, June 24, 2024 - to be considered.
Recipient(s) will be notified of the award ahead of the event.
If selected, recipient(s) must confirm their ability to attend the event and complete the registration for the event within three weeks of notification of award. A registration code will be provided.
For purposes of NASHIA promotion, the recipient(s) will be asked to provide post-conference feedback regarding their experience and the benefits of attending the event.
By accepting the Legacy Scholarship, recipient(s) provide permission to be featured in conference promotions, including, but not limited to, live appearances, conference materials, written statements, press or video interviews, and/or sessions with sponsors, staff, and board members.
Recipient(s) may be recognized at the SOS Conference.
NASHIA reserves the right to make changes to the Legacy Scholarship Award program with or without prior notice.

Initial here if you have read and agree with the rules above:*