Hunter Syndrome Family Fair 2024 Scholarship Application

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please complete the following form in its entirety by July 15, 2024 to be considered for a scholarship. Priority will be given to families with the most financial need, families that are newly diagnosed, and families that have not attended a MPS conference in over 5 years. Scholarships will cover air fair/mileage, taxi fees, and two night hotel stay for up to 4 people within the same household. Travel arrangements can be reimbursed, or Project Alive can book them for you if paying upfront would cause financial burden. Travel arrangements that are made by the awardee must be submitted for approval prior to booking to receive reimbursement. Scholarship awardees will need to attend one meeting with Project Alive to establish travel arrangements, sign an agreement letter, and confirm receipt of award email by the deadline. If you are not selected for the scholarship, you will be placed on the waitlist in the event there is a cancellation or additional funding is obtained by Project Alive.

Full name *

Email address *

Home street address *

Zip code *

Name of affected child/adult (please write "self" if applicable) *

Year of diagnosis *

Year of birth of affected individual *

Has this person passed? *

Yes

Type of MPS II *

Neuronopathic (severe)

Attenuated

Name of second adult (write N/A) if no other adult is in your household) *

Name and ages of additional children attending *

Have you attended an in person MPS conference before (including with other organizations)? *

Yes

Yes, but has been over 5 years

Household size *

Household income *

$0-30,000

$30,001-75,000

$75,001-100,000

$100,001-150,000

$150,001-200,000

$200,001 or more

Please tell us why you would like to attend this event and how it will impact your family. *

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Project Alive. Report Abuse

Forms