Vaping Prevention Workshop Travel Scholarship Application
HAIS in partnership with the Department of Health are pleased to offer needs-based Travel Scholarships for Neighbor Island administrators and teachers from HAIS Member schools to attend The Stanford Tobacco Vaping Prevention Training, thanks to funding made available by the Tobacco Prevention & Control Trust Fund.

Neighbor Island Schools may apply for a maximum of 3 travel scholarships – 1 head of school, 1 administrator and 1 teacher. The awards are intended to defray the costs of attending the Stanford Tobacco Vaping Prevention Training and can be used to cover the following:
- Roundtrip Inter-island airfare to and from the island on which your school is located for all 3 attendees (up to $250 each and does not include upgrades)
- Ground transportation - attendees from the same school are encouraged to use the same mode of transportation to travel to the training (ie. share 1 car rental, 1 taxi, etc. Up to $51 per person)
- Substitute Teacher expense - only applicable for classroom teachers (up to $179).

The total amount granted to any 1 school is not to exceed $1082, which includes up to 3 round trip inter-island airfares, shared ground transportation and substitute expenses for 1 classroom teacher.


Reimbursement of expenses up to the amount of the award will occur upon completion of the event and will only be made once attendance is verified at the workshop.. Please note that an itemized expense report along with all receipts must be submitted to HAIS, in order to receive the funding.

Please complete the below application by October 25th. Scholarships will be granted on a first-come, needs basis, as funding is limited. Notifications will be sent upon review. Scholarships may be used to attend either workshop, so long as a workshop is not being offered on the island where your school is located.

Workshop Locations:
6th - Oahu - Location: Saint Louis School
7th - Maui - Location: Kamehameha Schools, Maui Campus

Please contact Deanna D'Olier, at ddolier@hais.us, with any questions.
School Name *
Your answer
Name of Person Completing This Form *
Your answer
Job Title *
Your answer
Email *
Your answer
Telephone Number *
Your answer
Preferred Mailing Address *
Your answer
State/Province *
Your answer
City *
Your answer
Zip/Postal Code *
Your answer
Island *
Full Name of Person 1 attending the workshop: *
Your answer
Title of Person 1 attending the workshop: *
Your answer
Full Name of Person 2 attending the workshop (if applicable):
Your answer
Title of Person 2 attending the workshop (if applicable):
Your answer
Full Name of Person 3 attending the workshop (if applicable):
Your answer
Title of Person 3 attending the workshop (if applicable):
Your answer
Which workshop will you attend *
Travel Scholarships Requested (select all that apply): *
Required
Signature (Insert or type in italics) *
Your answer
Date
MM
/
DD
/
YYYY
Mahalo!
Submit
Never submit passwords through Google Forms.
This form was created inside of Hawaii Association of Independent Schools. Report Abuse - Terms of Service