DIC5 Scholarship Application Form

1. Name*

First NameLast Name

Email*

example@example.com

Mobile/Text Number*

Please enter a valid phone number.

2. Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

3. Eligibility. Which scholarship(s) are you applying for? (You can only pick one).*

Diversity Scholarship: for applicants who represent diverse backgrounds.First-Timer Scholarship: for applicants attending DIC for the first time.Hardship Scholarship: for applicants experiencing financial challenges.

4. Have you attended Deaf Interpreter Conference before?*

NoYes

5. Do you plan to attend the entire conference?*

YesNo (please stop here, not eligible for scholarship)

6. Are you receiving financial support from Vocational Rehabilitation (VR) or another funding agency to attend DIC5?*

NoYes (please stop here, not eligible for scholarship)

7. About You: Please tell us a little about yourself and your background.*

8. Motivation: Why do you want to attend DIC5? What do you hope to gain from this experience?*

9. Community Impact: How do you plan to apply what you learn at DIC5 to your community or professional work?*

10. Scholarship Fit:

If applying for Diversity: How do your lived experiences shape your perspective and involvement in the community?

If applying for First-Timer: What excites you most about attending DIC5 for the first time?

If applying for Hardship: Please describe your current financial circumstances and why this support would make a difference.

Type your answer below (You can submit ASL version instead - type ASL version and post your link in the next question):*

11. ASL Video Upload (insert link; if YouTube unlisted)*