Scholarship Request Form School's Out, Make It Count Conference
Conference Scholarships are awarded based on demonstration of need. Complete the request form by September 1, 2021.
Your Name *
Your email address
The name of your school, program or organization *
School, program or organization mailing address
Name of the person attending the conference (attendee)
Attendee's email address
List the Attendee's job title/position *
Does the conference attendee work for a youth/afterschool program or are you an educator in a classroom? *
What days does your program operate? (check all that apply) *
Required
Hours of Operation (example M-F 7AM-6PM, weekends 9AM-4PM) *
The activities we provide to youth (check all that apply) *
Required
The ages served by our program (ages of youth) *
The number of children/youth served by our program *
To be eligible for a scholarship the following items are required of my program. (checkmark all that are completed) *
Required
Has the Attendee attended the School's Out, Make It Count conference in past years? (If yes, please list years): *
Has the School/Program/Organization attended the School's Out, Make It Count Conference in years past, but not this specific Attendee? If so list the year(s) the School/Program/Organization has attended the conference *
Please describe your program’s primary source(s) of staff professional development (list which organizations you receive training and workshops from for your staff) *
Why are you applying for a scholarship to “School’s Out, Make It Count”? *
I am applying for a scholarship to cover Conference Registration (admission to the conference)
Clear selection
I am applying for a scholarship to cover gasoline cost to travel to the conference in Phoenix, AZ
Clear selection
I am applying for a scholarship to cover additional expenses related to attending the conference. List the expense, then list how much the expense costs (i.e. hotel room for 1 night, $150). Note: Assistance with hotel room expenses is only awarded to those who travel more than two and a half hours.
I understand and agree to the Terms and Conditions of receiving a scholarship: Individuals or organizations that are selected and choose to accept scholarship assistance will be required to sign a Memo of Understanding. The M.O.U. will indicate: 1) the dollar value of scholarship assistance, 2) the individual/organization’s intent to utilize 100% of the offered scholarship, and 3) the date by which the individual/organization must provide AzCASE with a notice of cancellation in order to avoid liability for any unused registrations or scholarship funds. All scholarship winners will be expected to volunteer for a work shift at the Conference such as, but not limited to, check-in table assistant, room assistant, or lunch assistant. Volunteer opportunities will be provided closer to the date of the event. Not all scholarships will be paid prior to the conference. *
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