2022 ECI Summer Institute MIECHV Scholarship form

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Eligibility Requirements:

**You must currently work at least part time or more in one of Oregon's home visiting programs serving infants and toddlers

**Scholarship is worth $100, you must commit to paying remaining costs (housing not included in scholarship)

If you want to request a home visitor scholarship, please complete this form and submit it, along with your ECI Summer Institute registration by Friday, July 22nd, 2022.

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Email *

First and Last Name *

Home Visiting program you work with *

Check all that apply:

Home Visiting Manager

Home Visitor

Home Visiting Supervisor

Altro:

Work Address (street, city, zip code) *

Preferred Email *

Contact phone number *

I confirm that I currently work with a Home Visiting program serving infants and toddlers. I also confirm that I will pay all fees and housing (outside of the $100 scholarship) at the time of registration.

Both presented and pre-read material

I agree

Avanti

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