5p- Society Financial Assistant Scholarship Application

Our Mission: To maximize quality of life for individuals with 5p- and their families.

Overview

Applicants are evaluated by the Scholarship Committee of the 5p- Society Board of Directors and are handled in a confidential manner. The Board has received donations to fund five (5) scholarships in 2017.

Applicant must show a good faith effort to obtain funding through other sources. For example, a state or local organization that provides funding must be contacted prior to asking for help from the 5p- Society.

It is important to note that no cash or check will be provided to the applicant. Covered expenses are paid directly to the hotel and to the Conference Committee.

For questions, please contact Laura Castillo, 5p- Society Executive Director at 888.970.0777 or director@fivepminus.org

Guidelines

The applicant must be a member of the 5p- Society, in good standing and current with membership dues. Membership is $25.00 per year and must be paid prior to awarding a scholarship.
A family can only receive financial assistance once every three (3) years.
Applications must be submitted online by May 1, 2017. All fields must be completed. Applicants will be notified of the results by May 15, 2017 via e-mail.
Expenses covered by scholarship. Only these fees are covered:
- Registration fee of $150.00, this includes registration for up to 2 adults and 2 children.
- Room and tax for one hotel room for three (3) nights of the conference (Thursday, Friday, and Saturday). This does not include any incidental hotel charges (telephone, pay TV, room service, etc). The 5p- Society will pay the hotel fee directly to the hotel.
- Sibling activity fees for up to 2 siblings.
The family must be able to travel to the conference at their own expense. The 5p- Society is not able to assist with travel expenses.
Expenses not-covered by scholarship. Applicant must budget for and be prepared to pay all other expenses, including but not limited to:
- If flying, round-trip airfare to conference city (Milwaukee) and transportation from airport to hotel and back.
- If driving, cost of gas and hotel parking fees (if any).
- Meals not specifically included in the registration fee.
- Incremental registration fee, outing fee, and sibling activity fees for additional family members beyond the 2 adults and 2 children.
- Incidential hotel charges.
The 5p- Society will make your hotel reservations. If you already have a room reserved, please contact Laura Castillo, so she can add the room(s) back into the 5p- room block.
You will need to write a brief narrative after the conference about your experiences (can be confidential) for the 5P News (the 5p- Society newsletter).

Check the box to acknowledge and accept these guidelines

Applicant's Name*

First NameLast Name

Spouse's Name (if attending)

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Area CodePhone Number

E-mail*

Name of Child or Adult with 5p-*

First NameLast Name

Date of Birth of Child or Adult with 5p-*

MonthDayYear

How many adults will be attending conference?*

How many children will be attending conference*

Will you be flying or driving to the conference?*

flyingdriving

Are you a member of the 5p- Society?*

YesNoUnsure

Have you attended a 5p- Society conference in the past?*

YesNo

If yes, what year(s)?

Have you received financial assistance for a conference in the past?*

YesNo

If yes, what year(s)?

Applicant's occupation and place of employment*

Spouse's occupation and place of employment

Please tell us about your family:*

What are you hoping to gain by attending the conference?*

List all agencies you have contacted for conference assistance and the results.

Attach supporting documentation from above agencies here, or send via e-mail to director@fivepminus.org

Upload a File

Please provide an overview of why you need financial assistance:*

I have fully completed this application and would like to be considered for a scholarship

I have sufficient funds available to pay for non-covered expenses.

Please type your full name to proceed with this application*

Please type today's date to proceed with this application*

MonthDayYear

Financial Assistance Scholarship Application 2017 5p- Society Annual Conference

Guidelines