FICPFM 2016: Scholarship/Subsidy Application
The 2016 FICPFM National Conference is an opportunity for formerly incarcerated people & family to come together to continue the Movement. We are able to offer a limited amount of reduced or free registration scholarships, as well as housing, transportation, & meal subsidies. Please submit the application for consideration & you will be contacted by a FICPFM 2016 organizer soon.

Scholarships & subsidies are awarded based on need. While no-one will be turned away for lack of funds, Lodging, Transportation, & Meal Subsidy recipients are requested to place a deposit cover the event of late cancellation.

First Name
Your answer
Last Name
Your answer
Email
Your answer
Phone Number
Your answer
Address (Street)
Your answer
City/Town
Your answer
State
Your answer
Zip Code
Your answer
How do you gender identify?
Required
Are you formerly incarcerated?
Required
Have you had contact with the criminal justice system?
(i.e. arrest, probation, juvenile, etc.)
Required
Organization / Business
Your answer
What type of assistance are you requesting?
NOTE: Housing subsidy includes a single bed in a double room. No single rooms (but no double / triple bunks, either!). Check all that apply:
Required
Are you requesting a full or partial Scholarship / Subsidy?
For each type of requested (Registration, Lodging, Transportation, &/or Meal), what are you able to cover, and with what do you need assistance?
Your answer
What are you able to contribute to the National Conference?
(i.e. Lead a Workshop / Breakout Group on a specific topic, Photo/Interview/Write articles for publication, Perform Entertainment, etc.)
Your answer
What are you able to contribute after the National Conference?
(i.e. Publish articles in local media, share experience with local activist group, start a AOUON chapter in your area, etc.)
Your answer
Given that scholarships & subsidies are limited, please share any circumstances that we should take into consideration:
Your answer
Please share anything else you'd like us to know about yourself:
Your answer
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