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Conference & Continuing Education Scholarship Application
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Today's Date: 
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Full Name
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Email Address
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Which WIC Project do you currently work for and what is your role?
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Which conference or continuing education opportunity are you requesting scholarship funds for? Please include a link to the event details.
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Why do you want to attend this event?
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Date(s) of event
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What is the cost of registration for this event?
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Are there any other costs associated with attending this event? Costs may include mileage, hotel, meals, etc.
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If there are costs beyond registration, please calculate and share them here. (Mileage, hotel, meals, air fare, transportation to/from site, etc.)
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If there are costs beyond registration, is your local agency willing to cover some or all of those costs?
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Do you have approval to attend this event from your local agency/supervisor?
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Are you be able to attend this event without scholarship funds?
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Share any WWA activities you have participated in, such as professional development, committees, board membership, etc.
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If selected, who will reimbursement need to be submitted to? 
Please include name, phone number and mailing address.  
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