NHSA Attendance Scholarship Form

DEADLINE: March 25th, 2017 @ 11:59pm EST

 

This form must be completed by the deadline stated above. All scholarships are based on available funds and will only be awarded if ALL Convention events have been attended.  It is the responsibility of the requester to check-in to all required events.  Scholarships will also be awarded on a first-come-first-serve basis.  If your university covers your conference expenses, you may not be eligible for certain or all scholarships.  Refund requests will be evaluated on a case-by-case basis and a decision will be made by NHSA as to the amount of the refund.  This form should be filled out ASAP to request a refund.  This form should be completed and submitted electronically. 

 

Should you have questions or concerns, please contact NHSA at nhsa@nhsaofamerica.org.

 

General Attendee Information
Name *
Name
Address *
Address
Phone *
Phone
Please provide the full name of your university. Put N/A if you are an alumni.
Put N/A if you have graduated.
Conference Information
Can be found on your Eventbrite confirmation.
Attendance Scholarships
Check all that apply *
Note: (1) Travel scholarships are only available for those who have traveled from outside a 7 hour driving distance from Los Angeles (per Google Maps); (2) Refund requests are only available for those who did not attend the convention.
Which ticket did you purchase *
If you did not purchase one of the two tickets below, you are not eligible for a scholarship.
Travel Attendance Scholarships
$
Events
Events Attended *
Please select all events that you attendeed
Signature
Will you be submitting additional documents to NHSA? *
Additional documents include travel itinerary (clearly indicating your name, cost of travel, and travel information), receipts, etc. Email all documents to nhsa@nhsaofamerica.org with your name in the subject bar.
By typing your full name below, you agree to the above.
Date
Date
Please provide today's date.