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2024 NODCC Conference Scholarship Application-Adult with DCC
The National Organization for the Disorders of the Corpus Callosum (“NODCC”) has a limited number of scholarships available to assist in covering the registration fees for the NODCC Conference. This scholarship covers registration fees only and does not cover any room or travel expenses($300 value). SCHOLARSHIP RECIPIENTS MUST ATTEND THE NODCC CONFERENCE OR IT WILL BE FORFEITED. Preference will be given to applicants who have never attended conference (or significant time has passed since attendance) and financial need.
Those applying for a scholarship must submit this form by May 15, 2024.
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First Name of Adult with DCC
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Your answer
Last Name of Adult with DCC
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Your answer
Street Address
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Your answer
City, State, Zip Code
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Your answer
Country
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Your answer
Primary Phone Number
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Your answer
Email Address
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Your answer
Birth Date
MM
/
DD
/
YYYY
Parent/Guardian First and Last Name, if applying for an adult DCC applicant
Your answer
Scholarship applicant's family income range (used as one factor to assess applications):
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Choose
Less than $25,000
$50,000-75,000
$25,000-50,000
Option 4
If income is above $75,000, please explain any mitigating circumstances that create a need for financial assistance to attend the 2022 NODCC Conference (i.e., large family, medical or other substantial expenses, such as college tuition, other factors).
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Your answer
Has the applicant attended a conference in the past?
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Choose
Yes
No
Describe any issues or problems you are experiencing because you have DCC or are caring for someone with a DCC that you hope the conference might help you to resolve or improve.
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Your answer
Any additional information you would like to provide relevant to the request?
Your answer
The NODCC may use the applicant's name, picture and story in future marketing materials
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The NODCC may use the scholarship recipient's name, picture, and story in future marketing materials.
The NODCC may use the scholarship recipient's name and story but no pictures in future marketing materials.
The NODCC may use the scholarship recipient's story but change his/her name and no pictures.
The NODCC may NOT use the scholarship recipient's name, story, or picture in future marketing materials.
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