Conference Scholarship Request Form
Please fill this out for all scholarship requests EXCEPT NSRH Annual Activist Conference. Please DO NOT use this form to request funds for the NSRH Activist Conference.

A limited number of scholarship up to $250 are available to members of active NSRH chapters. Scholarship awards of less than $250 may be awarded.

Members of active NSRH chapters are eligible for one award of up to $250 per fiscal year (July 1-June 30).

You will be notified of your award via email. Please complete the Scholarship Award Letter of Acceptance that will be attached to your award notification email, and submit, along with receipts to cassandra@nssrh.org.

Your award check will then be mailed to you.

After the conference, please complete the Conference Report Form that will be emailed to you, and submit photos to NSRH. Failure to compete this form will make you ineligible for future awards. Photos and quotes from this form may be used in NSRH grant and promotional materials.

Questions? Email Cassandra Belson, Program Director at cassandra@nssrh.org.

Your First Name: *
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Your Last Name: *
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Your email address: *
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Your phone number: *
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Your chapter affiliation: *
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Your degree program and school: *
Your answer
Your date of birth:
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Mailing address (where would you like a check mailed?): *
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To what conference/activity are you seeking assistance (please include dates and locations, unless restricted, such as NAF): *
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Emergency contact information (Name, relationship, email, phone number and type [cell, home, work]): *
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Total estimated travel costs: *
Your answer
Total registration costs: *
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Total amount you are requesting: *
Your answer
Mission: Nurses for Sexual and Reproductive Health provides students, nurses and midwives with education and resources to become skilled care providers and social change agents in sexual and reproductive health and justice. We envision a world in which all people have access to just and dignified full-spectrum reproductive and sexual health care. With the NSRH Mission in mind, briefly tell us how this conference supports the NSRH mission. *
Your answer
How will your attendance at this conference affect you or your future practice? *
Your answer
Please be aware that if you receive funding, you will be required to complete the NSRH Conference Scholarship Reporting Form. In addition to some basic details about the conference, you will be asked to write a short piece (2-3 paragraphs) describing the conference and some things you learned. Please share a photo or two from each conference as well. This write up (and photos) may be used on our website or other media. You will be emailed the NSRH Conference Scholarship Reporting Form shortly after you attend the conference you are applying for. Failure to complete this form will result in ineligibility for future funding. By clicking agree below, you are acknowledging that you agree to complete the reporting requirements: *
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