NHADACA

Have an account? Click here to log in...
CSP Scholarship Application
First Name *
Last Name
Email *
Phone *
Title *
Agency *
Credentials *
Are you a CSP Program participant? *	Yes No
If no, you are not eligible for this scholarship. If you're interested in participating in the CSP Program, please fill out an application form found here: https://www.nhadaca.org/CSP
I am working towards *	CRSW LADC MLADC Re-licensure to any of the above credentials
NHADACA Member? *	Yes No
If I don’t receive a scholarship: *	My agency will pay I will pay I will not attend
Do you plan to attend both days of the NH Behavioral Health Summit or 1 day? If 1 day, please specify which date (Dec 8th & 9th) *
In 3-5 sentences, please explain how this scholarship would assist you with your professional goals? *
I agree that if I get an award, my statements may be used in association with fundraising, publications and the NHADACA website. *	Yes No

Timeout Warning