2017 Statewide Convening Scholarship Application
This convening will bring members of immigrant and refugee communities, grassroots organizations, and advocates from across the state together for training, networking and, most importantly, movement building. Together, we will envision ways to build a more unified immigrant rights movement for our state and work together to create a more just and inclusive Pennsylvania.

Although we have tried to keep our registration fees as low as possible, we recognize that travel and hotel costs may make attendance at the 2017 Statewide Convening inaccessible for many community members. In order to ensure that everyone is able to attend regardless of their financial situation, we are offering small scholarships to help cover these costs.

If you are selected to receive a scholarship, the check will be given to you when you check in at the 2017 Convening on May 7, 2017.

We will be informing everyone of scholarship decisions by May 1, 2017.

Please fill out this form completely!

Name (First & Last)
Your scholarship check will be made out to this name unless otherwise requested.
Your answer
Address
Your answer
City, State, Zip
Your answer
Phone
Your answer
Email
Your answer
Organization
Please indicate if you are attending as a representative of an organization.
Your answer
If you are attending as a representative of an organization, will they be assisting with your costs? If no, please explain.
Your answer
Why do want to attend the 2017 Convening?
Your answer
Are you a PICC member?
What Scholarship Level are you applying for?
We have limited funds for scholarships. In order to make sure we can assist as many people as possible, please request the smallest amount that you need.
What will you use the scholarship for?
Required
Have you registered for the 2017 Convening?
If you have not yet registered for the 2017 Convening, please do so!
Is there anything else we should know?
Your answer
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