CEA Ambassador Fellowship Application 2018-2019

Colorado Council of Learning Disabilities (CCLD)

Professional Development Scholarship
Name *

First Name Last Name
Email *
example@example.com
Phone Number *

Area Code Phone Number

Home Address *

Conference Title: *
Sponsoring Organization of Conference (if applicable)
Location of Conference *
Start Date of Conference *

Month Day Year
Date Date Picker Icon
Describe the key focus and basic content for the conference or workshop and its relevance to your current teaching assignment. If you are attending a conference, list the specific sessions you plan to attend. List anticipated expenses: These may include registration, hotel, and mileage or other related expenses. *
Should be Empty:

Colorado Council of Learning Disabilities (CCLD)