Scholarship Request Form - Updated

This form should be used for any applications for scholarship from the Oregon APCO-NENA Chapter.

Please note: eligible scholarship opportunities will be listed in the dropdown box below

* Email Address

* Scholarship Request There are no open scholarships at this time. Check back at a later date.

* Is this Scholarship Request for you or on behalf of another applicant in your office? advise if for self or other

Other

If the Scholarship Request is for someone else, please share your name & email address as the Nominator

Nominator Name

Nominator Email

Name

Position Title

Agency/Organization

Email Address

Phone Number

Are you a Local or National Committee Chair? advise yes or no

Are you a Local or National Committee Member? advise yes or no

Have you been published in an APCO or NENA magazine? advise yes or no

Are you an APCO major award winner? advise yes or no

Why do you (or the person you are nominating) want to attend this training?

How will this training benefit your agency?

Have you been awarded a scholarship through Oregon APCO/NENA before? advise yes or no & how many times

If yes, advise the year of last awarded scholarship advise of year awarded

Are you a member of APCO or NENA? (Non-membership does not directly disqualify you) advise if APCO, NENA, both or neither

As part of this scholarship, please share what you need financial assistance with: example: lodging, travel, training or conference registration, etc

If you indicated assistance for hotel and/or travel, please estimate your travel/lodging costs.