SENTAC Endowment Application Form
Application for support to sttend the SENTAC Annual Conference. Please complete all required fields and upload supporting documents as applicable.
Applicant Information
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Organization / Employer
*
Professional Title / Role
*
Years in Practice (if applicable)
Please check all that apply.
*
First time attendee
Speech-Language Pathologist
Audiologist
Trainees (residents, fellows, or equivalent)
Early-career professionals (within 5 years of completing training)
International learners engaged in pediatric communication or ENT-related fields
Do you reside more than 60 miles from the conference location.
*
Yes
No
Are you a member of SENTAC or do you have an application submitted?
*
Yes, I am a member
Yes, my application is submitted
Neither of the above
Application Questions
Why do you want to attend this conference? (What are your goals, what sessions or themes are most relevant to you?)
*
How will you share what you learn with others? (Describe specific plans—presentations, workshops, mentorship, articles, etc.)
*
How does your work/study support the mission of SENTAC? (Describe your current work and how it aligns with the society’s goals or focus areas.)
*
Agreement & Signature
I agree, if selected for funding, to submit a brief written or video testimonial after attending the conference. This testimonial may be used for promotional or reporting purposes by SENTAC.
*
I agree to provide a post-conference testimonial
Signature
*
Date
*
-
Month
-
Day
Year
Date
Optional: Additional Documents
Résumé or brief bio
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Letter of support from supervisor or colleague (recommended)
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Conference registration confirmation (if already registered)
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of
Submit Application
Submit Application
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