NCIMHA Membership Scholarship Request
Equity, diversity, inclusion, and access are important to NCIMHA as an organization. As such, we are able to offer full or partial scholarships for annual membership. Please complete the form below and a NCIMHA will representative will be in touch with you shortly regarding the available scholarship options.  
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Email *
Name *
Which county do you live in? *
Position/Role: *
Agency *
NCIMHA has a commitment to diversity and equity inclusion and access in our work and as such it is important that we inquire about your race/ethnicity. Data collected from this question will inform program development and will help NCIMHA identify gaps and disparities. Please check all that apply and if you select "other" you will be given the opportunity to self- describe as you choose.
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What is your gender? *
Which workforce sector best describes your work? *
How many years have you worked in early childhood?
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I have approached my employer about paying for my NCIMHA annual membership, but they are unwilling/unable to pay because:
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Hourly Wage Rage or Annual Salary (select one):
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