Request edit access
CCGH Community Registration Scholarship Application
Please fill out the form thoroughly and provide all possible details. Leaving sections incomplete or blank may lead to your application being denied.
Sign in to Google to save your progress. Learn more
First Name *
Last Name *
Email *
Confirm Email
Country *
Province/State *
City *
Age *
Gender *
Would you like to be considered for an in-person scholarship or virtual scholarship? *
If you are not selected for an in-person scholarship, would you like to still be considered for a virtual scholarship?
 *
This scholarship aims to support people from key populations, as well as people working in Community-Based Organizations whose work is focused on supporting these key populations.

Please specify all of the communities to which you self-identify with:
 *
 This scholarship also aims to support people working in Community-Based Organizations whose work is focused on supporting these key populations.
 
Do you work or volunteer at a relevant Community-Based Organization?
 *
If you selected "yes" to the aforementioned question, please provide the following details:
1. Job Title
2. Organization Name

* Write "NA/Not applicable" if this question does not apply to you.


 *
Please specify all of the communities to which you have experience working/volunteering with: 
 *
Have you submitted (or are you involved with) a research abstract for this Conference?
 *
Have you attended the CCGH in the past year?
 *
Why would you like to attend CCGH 2023?
 *
 What experiences will you be bringing to CCGH 2023?
 *
 How will you share the knowledge gained with a larger at-risk community or organization after the conference?
 *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms