2007 Adolescents & Families Conference Scholarship Application

Each scholarship will cover all but $35.00 of the conference fee. Scholarship recipients will be responsible for their own travel, lodging, and meals not included in the conference fee.

A portion of the scholarship funds are dedicated to applicants who are members of the Lac Courtes Oreilles tribe or tribal staff.

To apply:

1. Briefly describe the goal you have for this training and the three outcomes you wish to achieve as they relate to your occupation or area of interest.
2. Please submit
   a) this completed application
   b) your completed conference registration form, and
   c) your $35.00, non-refundable, registration fee. Should your application be denied, the $35 can be applied toward the full price of the conference.
3. Scholarship application deadline: March 1, 2007. Applications will not be accepted after this date.
4. Applicants will be notified of the decision by March 19, 2007.

Applications that are incomplete, late, or without the $35 registration fee will not be considered.

Briefly describe three goals you have for attending this conference:

*Outcome One:

*Outcome Two:

*Outcome Three:

*Name of Registrant:
*Home Phone:	(please include area code)
*Home Address:
*Home City:
*Home State:
*Home Zip Code:
*Agency/Business:
*Work Phone Number:	(please include area code)
*Job Title:
*Work Address:
*Work City:
*Work State:
*Work Zip Code:
* E-mail:
Tribal Affiliation (if any):

* Required fields

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Questions? Call (715) 836-3636