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AdvocacyNJ Scholarship Application
This form is acts as an application to apply for scholarships offered by AdvocacyNJ.
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Email
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Your email
Name of Applicant
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Your answer
Proposed Applicant Beneficiary Name (write self if you are requesting a scholarship on your own behalf)
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Your answer
Phone Number
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Your answer
Full Address
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Your answer
Job Title of Applicant
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Your answer
Scholarship Selection
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Choose
Scholarship funds to provide Advocacy Services within AdvocacyNJ
Scholarship funds to pay for an AdvocacyNJ Training or Workshop
Scholarship funds to attend a workshop for continuing education or training
Scholarship funds for a diagnostic and/or clinical evaluation
How will you be using the scholarship? (training names, evaluation type, doctors, etc.)
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Your answer
Why you are asking for this scholarship?
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Your answer
Why you are asking for this scholarship?
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Your answer
How much funding are you requesting?
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Your answer
What is one thing you wish more people understood about disabilities?
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Your answer
Agreement
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I understand that I am not guaranteed any funding by submitting this scholarship
I have read the scholarship parameters on AdvocacyNJ's website and fit the criteria (if selected, confirmation will be made)
I understand that it can take 1-3 months to process this application
Required
Signature- Please type name
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Your answer
Date of electronic signature
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