2026 Frances Fund Scholarship Application Form

"Connecting Minds, Changing Outcomes"
2026 Frances Fund Online

Scholarship Application Form

for

BIAMD Members with Brain Injuries

and/or

Their Family Members

Please fill out one Online Scholarship Application Form per Person.

This Application is not a guarantee that you will receive a scholarship. We try very hard to accommodate as many individuals and families as possible given the funds available.

The scholarship reduces the two day rate to $90 and the one day rate to $60.
I am a member of the Brain Injury Association of Maryland.

YesNoOther
I am

An Individual with a brain injuryA family member of an individual with a brain injuryOther
If you checked "Other", please explain.
I. Personal Data:
Full Name

First NameLast Name
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Address Given

Work AddressHome AddressOther
Address

Street Address

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CityState / Province

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Phone Number Given

Work NumberHome NumberCell Number
Phone Number

Area CodePhone Number
Requesting

Thursday, April 3, 2025Friday, April 4, 2025Both Days
Above is the information for the sessions on both Thursday and Friday. When you are selecting a session, please make sure you are only selecting one session per break out.
Thursday, April 3rd from 10:00-11:00am. I want to attend:

A1A2A3A4A5
Thursday, April 3rd from 11:30am - 12:30pm. I want to attend:

B1B2B3B4B5
Thursday, April 3rd from 2:45pm - 3:45pm I want to attend:

C1C2C3C4C5
Friday, April 4th from 10:00-11:00am. I want to attend:

D1D2D3D4D5
Friday, April 4th from 11:30 - 12:30pm. I want to attend:

E1E2E3E4E5
Friday, April 4th from 1:30pm - 2:30pm. I want to attend:

F1F2F3F4F5
I would like to receive a scholarship and attend the conference because...
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