Parent Workshop Scholarship Request

Parent Workshop Scholarship Request

Individuals are welcome to apply for both the in-person and live-stream scholarships, but please note that winners of the in-person scholarship will not be eligible for the live-stream scholarship. This scholarship does not cover the cost of airfare, lodging, meals, or attendance to any other Symposium event. Practicing Occupational Therapists, other treating professionals, and OT students are not eligible to receive the Parent Workshop Scholarship.
Contact Information

(For internal use only)
Name and Title*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Primary Phone Number*

Area CodePhone Number
E-mail*
Number of children*
Age(s) of child(ren):*
Diagnosis/Diagnoses*

ADHDAuditory ImpairmentAutismFragile X SyndromeLearning DisabilitySensory Processing DisorderVisual ImpairmentOther
Briefly state what you would hope to gain by attending the Parent Workshop this year*
4-6 sentences
Are you interested in attending in-person or online?*

In-personLivestreamEither
Should be Empty:

Contact Information