2023 Roots Pre-Conference Scholarship Form
This form is for CHWs/CHRs/Promotore(a)s who want to apply for a registration scholarship to attend the 2023 Roots Pre-Conference on June 21st, 8:30-11:00 AM, at Wild Horse Pass - Gila River Resorts and Casinos in Chandler, AZ

This year's pre-conference theme: CHW Emergency Preparedness
During this training participants will:
• Identify local emergency risks and vulnerabilities.
• Present a model for the assessment of needs and the delivery of services to the community in distress.
• Review a community program to restate connection with ordinary life and resilience from loss and trauma.

Please read this information carefully before beginning the application.

The application is due on June 7th, 2023 and scholarship recipients will be informed on the status of their application on June 9th. The scholarship is for registration ONLY. The CHW is responsible for his/her transportation and lodging for the pre-conference.

This full pre-conference scholarship covers 100% of the registration costs. The price for CHW Admission for the Roots pre-conference is $50 USD.

The scholarship recipient will be responsible for his/her travel and accommodations during the pre-conference.

We have a limited number of scholarships available. Applicants will be chosen based on the following:

- Number of times you have received a pre-conference scholarship in the past (We want to give as many CHWs as possible the opportunity to attend)

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


If you have any questions about this form, please send an email to: info@azchow.org

Conference and pre-conference information is available at: https://azchow.org/roots-2023
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Full Name
Organization
Job Title
Are you a: 
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Years of experience as a CHW
Phone Number
Email address
Have you ever received a scholarship from AzCHOW to attend the AzCHOW Pre-Conference? If so, please mark all of the year(s) you received the scholarship.
In a short paragraph, please tell us why you want to attend the 2023 Roots Pre-Conference
If I am granted the scholarship, I am aware that I will be responsible for my travel and lodging expenses. 
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