Conference Scholarship Application
The purpose of this scholarship is to provide financial assistance for attending educational conferences that are related or applicable to Spina Bifida.

Approved expenses may include registration, travel expenses, and lodging.
Application Requirements:

• Applicant must have a Spina Bifida diagnosis, or be the parent/leagal guardian of an individual with Spina Bifida. You may be asked to provide proof of diagnosis.
• By submitting this scholarship form, you agree to write and submit a few paragraphs describing your experiences at conference, along with a photo. The WMSBO may print and distribute your photo and paragraph.
• Applicant must reside in West Michigan.
Applicant Name *
Additional applicant(s) and relationship
Email *
Phone *
Adress *
Have you attended a WMSBO event in the past year? *
Have you sought funding from other resources? *
If yes, what sources?
Name of Conference *
Website of Conference *
Registration Amount *
Number of registrants *
Estimated travel expenses (at the current federal milage rate) *
Name, address, and phone of Hotel
Hotel Expenses
please include cost per night, the number of nights, and the total.
Amount requested *
Comments
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