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SC Autism Society's 2008 Workshops

SCHOLARSHIP APPLICATION

* All Fields Required.
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* Your Name
* Your Address 1
Your Address 2
* Your City    * State       * Zip Code   
* Phone Please include area code.
* Your E-mail (Changes will be sent by email.)

Are you a:

YES

NO

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YES

NO

Choose
Sessions

Session Name

Location

Date

Deadline for
Requests

# of Scholarships Requested

(1 or 2)

Name of 2nd Scholarship Recipient

(if requested)

Inclusion

Columbia

06/12/08

06/07/08

I am a parent of a child with an ASD who is requesting a scholarship for the above-referenced workshop(s). I understand that the scholarships for parents offered by SCAS are to attend the Workshops I have indicated above. There are a limited number of scholarships offered statewide. Scholarships do not include hotel or travel expenses. If I am awarded a scholarship and do not attend the workshop without notice to SCAS, I will be charged the full registration price.

By typing my initials here, I indicate request for scholarship(s) above (in lieu of signature)


South Carolina Autism Society ♦ 806 12th Street ♦ West Columbia, South Carolina 29169 ♦ 803-750-6988