Nobis Project Medical Form

Registration & Scholarship Application
REGISTRATION APPLICATION
Participant Name*

First NameLast Name
Participant Cell Phone Number*

Area CodePhone Number
Participant E-mail*
example@example.com
School / Organization Name*
Job Title / Grade / Subject Taught *
Please indicate how you learned about Nobis Project?*
I'm applying for the following program:*
prevnext( X )
VA / NC $1,275.00
Origin Stories: Indigenous & First Africans December 6-9, 2024 4 Day Program (includes accommodations and meals)

Total $0.00
I work at a ...*

Public SchoolCharter SchoolIndependent SchoolNon-Traditional School SettingOther
I'm applying as ...*
The other members of my group include (list their first and last names):
Please explain why you would like to participate in this field experience? *
What do you hope to bring to your school/organization and students after participating in the program? *
What skills would you bring to the program?*
Scholarship Assistance
Nobis Project is committed to working hard to make participation in our field experiences as affordable as possible. There are a limited number of scholarships available for educators. Because aid is limited, please carefully consider all the resources available that might help fund your participation before deciding how much aid to request. Visit our website for suggestions of additional funding opportunities: www.nobisproject.org/resources/#funding.

Please note, because funds are limited, we cannot guarantee that we will be able to award all the aid requested by applicants chosen to participate in the trips. You will be notified in writing as to how much aid you might receive shortly after submitting your registration application.

Scholarships are available first come, first serve so we encourage you to register early.
Amount of Assistance Requested:

5%10%15%
Should be Empty:

Registration & Scholarship Application

REGISTRATION APPLICATION

Scholarship Assistance