2019 International Conference Scholarship Application - Deadline: April 31, 2019
Please note the following terms before completing this application:

1. The International Scholarships are for families with a child diagnosed on a genetic report with SCN2A. Genetic report must be emailed to info@scn2a.org

2. Scholarship may cover up to 3 nights hotel, one family registration fee and/or travel assistance up to $500.

3. You will be notified whether your application has been selected for sponsorship sometime
between May 1st - May 8th, 2019

4. If approved the FamilieSCN2A Foundation will be responsible to reserve the hotel room. If you would like to stay at the Graduate Hotel for additional nights, that will be at the applicant's own expense. Scholarship for the Graduate Hotel are for August 1st thru August 3rd, 2019

5. Children are not permitted in the conference room, and formal childcare is not included. There will be snacks, drinks and activities in the hospitality room for children with SCN2A and their siblings. All children must be accompanied by a parent or caregiver at all times.

Name *
Your answer
Mailing Address *
Your answer
Phone Number *
Your answer
Which scholarship are you applying for? *
Required
Please list the first and last names of additional family members who will be coming to the conference with you and will be participating in any evening social events. Include the ages of all children.
Your answer
By clicking accept you acknowledge that if you are bringing a child, you will provide a caregiver that will stay with your child at all times during the conference hours. Children are not allowed in the conference room. *
If you plan to stay more than 3 nights, please check this box to indicate that you understand you will be responsible for the cost of any additional nights at the hotel. *
Required
Personal Essay: Please let us know your involvement in the FamilieSCN2A community and why attending the FamilieSCN2A Conference is important to you. 500 words or less (For more written space, please email us at info@scn2a.org) *
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of FamilieSCN2a Foundation. Report Abuse - Terms of Service