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 of any of the above credentials

Title of the Training Event *

Training Date *

What is the amount of the scholarship you are requesting? *

What is the registration fee for the training? *

NHADACA Member? *

Yes

No

If I don’t receive a scholarship, please: *

My agency will pay

I will pay

I agree that if I get an award, my statements may be used in association with fundraising, publications and the NHADACA website. *

Yes

No

In 3-5 sentences, please explain how this scholarship would assist you with your professional goals? *