Family Scholarship Application
Division for Early Childhood's Annual International Conference on Young Children with Disabilities and Their Families
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Age of Child/Children with Disability
Tell us about your family including your child(ren) with disabilities (including age) and your experiences with early intervention, early childhood special education, and other related services and experiences.
*
0/150
How would attending this year’s DEC Conference benefit you as a family member of a young child with a disability and how do you plan on using this information to benefit others outside of your family?
*
0/150
Are you currently employed in an early intervention, early childhood special education, or other related service area?
*
Yes
No
Please describe your employment.
Are you currently involved in local, state, or national organizations, boards, councils, committees, etc., in early intervention, early childhood special education, or other related service area?
*
Yes
No
Please describe your involvement.
Is this financial support necessary for your attendance to this year’s conference?
*
Yes
No
The award of this scholarship is up to $500. If you have a child, aged birth to 8, your conference registration will be waived. Other ideas for assistance may include costs related to hotel accommodations and travel. Please specify what you would use the scholarship for and how much you anticipate you would need to cover the cost.
Are you currently a CEC/DEC member?
*
Yes
No
Please enter your CEC/DEC membership number.
*
If you do not have your membership ID, please call or email CEC directly, 1-888-232-7733 or service@exceptionalchildren.org.
How are you currently involved in DEC?
*
Submit
Should be Empty: