Scholarship Application 2019
Email address *
Directions
Thank you for your interest in a scholarship to the 2019 NAMI Indiana State Conference on Friday, October 11, 2019.

Because of the generosity of the Indiana Division of Mental Health and Addiction and donors, we are able to provide no-cost registrations to a small number of people living with serious mental illnesses and family members. Applications will be evaluated based on NAMI membership (recipients must have an active NAMI membership), geographic location, and statement of need. Membership status will be verified. If you would like to renew a membership or become a member please visit www.nami.org/get-involved/join or call 1-800-677-6442. (Membership rates start at $5.)

This scholarship covers the cost of registration. Registration includes breakfast, lunch, all workshops, and access to exhibitors. Recipients will be notified by September 25, 2019.

We'd like to know more about your interest, please complete this form by September 20, 2019. You may also use the printable form and mail it in (https://drive.google.com/a/namiindiana.org/file/d/1SxTG6vtUfjThRi9hSjGapu1x2Zvkb5Jw/view?usp=sharing). You will be notified by email or phone if you are accepted and with next steps.

Printable form available at: https://drive.google.com/a/namiindiana.org/file/d/1SxTG6vtUfjThRi9hSjGapu1x2Zvkb5Jw/view?usp=sharing
First Name *
Your answer
Last Name *
Your answer
City *
Your answer
I am: *
Are you a NAMI Member *
*Must be an active NAMI member by September 20, 2019. Membership will be verified. To become a member now, visit www.nami.org/Get-Involved/Join
Describe your involvement with NAMI in the past 12 months. *
Examples: Did you attend a class or support group? Have you volunteered with a local or state affiliate?
Your answer
Email Address *
Your answer
Primary Phone Number *
Your answer
Have you received a scholarship to a NAMI event in the past 9 months? *
Does your ability to attend the conference depend on your receiving a scholarship to cover the registration fee? *
How will the conference benefit you? *
Your answer
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