2023 AzCHOW Conference Scholarship Form

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This form is for CHWs who want to apply for a registration scholarship to attend the 2023 AzCHOW Conference on June 21-22,2023 in Tucson, Arizona. Please read this information carefully before beginning the application.

The application is due on June 3, 2019 and scholarship recipients will be informed on June 10.. The scholarship is for registration ONLY. The CHW is responsible for his/her transportation and lodging for the conference. We have full scholarships and partial scholarship available.

The full scholarships covers 100% of the registration costs, and the partial scholarship covers 50% of the registration costs. CHW registration for the CHW conference is $100.

The registration includes AzCHOW membership, conference bag, afternoon snack on 6/20, and breakfast and lunch on 6/21. The scholarship recipient will be responsible for his/her travel and accommodations during the conference.

We have a limited number of scholarships available. Applicants will be chosen based on the following:
- Number of times you have received a scholarship in the past (we want to give as many CHWs as possible the opportunity to attend)

-Geographic area (we want to have as much representation as possible from different parts of Arizona)

-Financial need. Please seek funding from your organization before submitting this form. We want to reserve scholarships for CHWs who otherwise would not be able to attend.

For tips on how to ask your organization to sponsor you for the conference, please see this blog post: http://www.azchow.org/1117/how-to-ask-your-organization-to-sponsor-you-for-the-azchow-conference/

If you have any questions about this form, please reach out to Flor at christinam@azchow.org

Conference information is available at: http://www.azchow.org/2018-conference/

Name

Organization

Job Title

Are you a:

Volunteer CHW

Employed CHW

Clear selection

City and County where you work

Phone Number

Email address

How long have you worked as a CHW?

Which scholarship are you applying for?

Full scholarship (100% of registration costs)

Partial Scholarship (50% of registration costs)

Either a full or a partial scholarship

Clear selection

Have you ever received a scholarship from AzCHOW to attend the AzCHOW Conference? If so, please mark all of the year(s) you received the scholarship.

I have never received an AzCHOW scholarship to attend the conference

2018

2017

2016

2015

Other:

In a short paragraph, please tell us why you want to attend the 2018 AzCHOW Conference

I understand that if I am granted a scholarship, I will be responsible for transportation and lodging.

Yes

Clear selection

Submit

Clear form

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