Self-Advocate Scholarship Application

Full Legal Name(Required)

Preferred Name

Pronouns

(Like she/her, he/him, they/them.)

Phone Number(Required)

Email Address(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Is there an organization helping you with this application?(Required)

Yes

Is there a person helping you with this application? If yes, please share their information below.(Required)

Yes

Name of Person Helping You

First Last

Phone Number of Person Helping You

Email of Person Helping You

How do you speak up for yourself and others?(Required)

Tell us how you stand up for yourself and others in the I/DD community. (Examples: sharing what you need, helping others learn about the I/DD community, being part of advocacy groups.)

Why do you want to attend?(Required)

Please tell us why you want to go to the event. How will it help you as an advocate?

How are you involved with the I/DD community?(Required)

(Examples: taking on leadership roles, helping others, or joining advocacy groups.)

Do you need someone to attend the event with you for support?(Required)

Yes

If you answered yes to the last question, please explain what support they provide to help you.

Do you need any specific help or accommodations to attend the event? (Examples: sign language, wheelchair access, or help with reading materials.)(Required)

Please tell us why you need financial help to attend. How will this scholarship make a difference for you?(Required)

Community Support Letter (Optional)

Drop files here or

Accepted file types: doc, docx, pdf, Max. file size: 50 MB.

If you have a letter from someone who knows about your advocacy work (like a friend, mentor, or organization), you can include it when you send in this application. This letter is optional.

Signature(Required)

First Last

Date(Required)