Page Title

Your First and Last Name:

Who are you:
(choose one)

Type of Scholarship Request:
Choose one)

First and Last Name of
Second Parent:
(list only if a 2nd parent is attending)

Type of Scholarship Request
for the 2nd Parent:
(choose one)

Your Email Address:

Address
City
Zip Code:

County you live in:

Phone Number + Area Code:

Cell Phone:

Please list the age of the child or children in your family and indicate if they have a learning
disability or attention deficit disorder. Examples: Age 8 - LD, Age 12, Age 15 - LD & ADHD.

Under what category does your child or children receive services at school:
Hold the ctrl button to check all that apply.

Does your child or children receive services through a:
Hold the ctrl button to check all that apply.

Please briefly tell us why you want to attend the conference:

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Conference Scholarships Application For Parents

We have a limited number of full and reduced rate scholarships available to families whose financial situation
would make it difficult for them to afford the conference registration fee. When we run out of full scholarships,
we will offer you the choice to register at the reduced scholarship rate, but if you can afford to pay the $60
reduced registration rate, please apply for the reduced rate scholarship level so we can help as many families as
possible. Parents who are also a school employee, and whose registration fee is normally paid for or reimbursed
to them by their school system are not eligible for a parent scholarship.
Although no parent scholarship request will be turned down, we want to let you know that we are
   almost out of Full Scholarships. Please consider requesting the reduced rate scholarship
                                   so we can help as many parents attend as possible,
A limit of one full scholarship or two reduced rate scholarship per family may be awarded.
To apply for a scholarship, complete the information below and we will email you with confirmation of your request.
This information will help us complete our report to the grant provider. Your name, address or identifiable
information will NOT be released or used in our report.
                          Please Complete The Entire Application Before Submitting.

You will see a copy of your application after you press then Submit button,
you can then use your back button to return to our website.

Please give us two days to process your application and send an email reply.

Thanks to a grant from the Eli Lily Foundation, we are able to offer scholarships to Indiana Parents
and Guardians whose child has a primary diagnoses of a Learning Disabilities or Attention Deficit Disorders