AZ WUI Summit Scholarship Application Form

AZ WUI Summit Scholarship Application Form

Applications are now open and will be accepted continuously until two weeks before the summit. However, we will begin reviewing the applications and making awards on September 1. If selected, you will receive an email with instructions on how to register for the summit.
These full or discounted registration waivers and travel scholarships are intended to help those who need financial assistance to attend the summit and to increase the diversity of attendees.

What does the scholarship provide?

Free or discounted registration and/or funds to assist with the cost of lodging and travel.
We can offer up to $480 per person, and potentially more than $480 depending on the number of people who apply and the total amount of scholarship funds.

Who can apply?
- We encourage anyone who needs financial assistance to apply.
Applicants are selected based on the following criteria:
- How much support is needed (partial or full)
- Financial need – would they be able to attend if they did not get the travel grant
- Agency/organization – Is someone from an agency/organization not well represented for the event?
- Participation in the event
I. Personal Data

Tell us about yourself
Full Name*

First NameLast Name
Mobile No*
Email *
Where the confirmation will be sent
Mailing Address: Where reimbursement check will be mailed. *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Affiliation
Job Title
Are you a student?

YesNo
Dates of travel (mm/dd/yy)
Estimated travel expenses
Funding request $ (Max $480)
Do you need us to pay for your hotel or registration up front?

YesNoUnsure at this time
Estimated travel expenses. Mileage $.65/mile. Per diem $xx/day*
I understand I will pay for all travel expenses up front and receive reimbursement after the event (other than hotel and registration declared in previous question).

YesNo
Please provide a short description of why you are requesting a travel grant. What do you hope to get out of the event and how will it help your organization or community?
What is your role in the event?

I am presentingAttendeeI am on the organizing committeeOther
Will you be able to attend the event if the grant is not awarded?

YesNoUnsure
VIII. Applicant's E-Signature
By signing the space below, you are certifying that all information is correct. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.
Signature

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AZ WUI Summit Scholarship Application Form

I. Personal Data

Estimated travel expenses

VIII. Applicant's E-Signature