Halifax City Local Conference Grant Application
Full name: *
Six digit professional number: *
Contract status (Permanent, Probationary, term): *
School/Work site: *
Home mailing address: *
Home or cell number: *
Non-employer email address: *
Name of conference: *
Conference Location: *
Start date of conference: *
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DD
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End date of conference: *
MM
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DD
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YYYY
Brief description of conference: *
Conference Website: *
Conference registration fee: *
Have you applied for Article 60 funding? *
Have you applied for, or been approved for, other sources of funding? *
If yes above, what type(s) of funding:
Have you read, and do you understand the guidelines for Halifax City Local PD funding? *
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