First Name:

Last Name: 

Mailing Address (including number, street, town, and zip code):

Contact Number (cell/text/VP/etc.):

Title & Sponsor of Event: 

Date(s)

Location

Registration Deadline

Registration Fee

Have you applied for a NHRID scholarship in the past?

*I understand that if granted funds I am required to “give back” to NHRID as an active member either by joining a NHRID committee, teaching a local professional development workshop, running for office, or volunteering. Here is how I plan to "give back" to NHRID: