AFCC Regional Training Conference
September 27-29, 2007, Columbus, OH
Online Scholarship Application

Thanks to the generous support of AFCC members who contributed to the AFCC Resource Development Fund, four scholarships will be awarded for AFCC’s Regional Training Conference, Applications for High Conflict Families, Domestic Violence and Alienation, September 27-29, 2007 in Columbus, Ohio. One of the four scholarships may be designated to support a professional or full-time graduate student who resides in the greater Columbus area. The AFCC Resource Development Committee determines the number and type of scholarships available each year.

Conference Scholarships
Conference Scholarships include registration fees for the conference and one full-day pre-conference institute. Conference Scholarship recipients are responsible for funding their own travel, lodging, meals and all other related expenses.

ELIGIBILITY
Anyone may apply for a scholarship. Preference for all scholarships is given to AFCC members. If you are not a member and would like to join AFCC, please click here. All applicants must complete the entire application form to be eligible for consideration. Incomplete applications will not be considered. For more information on AFCC’s scholarship program (including criteria in selecting scholarship recipients), please view the Resource Development Committee page on the AFCC Web site.

Deadline: Application must be received by August 1, 2007.

Contact Information
Name
Address Line 1
Address Line 2	( optional )
City
State/Province
Zip/Postal Code
Country
Email
Telephone
Fax	( optional )
Discipline (check your professional disciplines)
Academic Judicial Officer Attorney Mediator CASA Volunteer Mental Health Professional Court Services Parent Educator Court Administrator Researcher Custody Evaluator Other Graduate Student   Guardian ad litem
Questions
1. Check box if you are an AFCC member
2. Check box if you have never attended an AFCC conference
3. Check box if you have never received an AFCC scholarship
4. Additional Funding Support
None  A portion of my expenses are paid by my agency, firm or other institution  All conference expenses are paid by my agency
5a. What is your current earned income?
Please Select Current Income Less than $30k $30k - $44k $45 - $59k $60 - $74k Greater than $75k
5b. Are there are any additional circumstances that AFCC should consider in determining your financial ability? If so, please specify.            No more than 150 words
6. How would your attendance at the conference impact services for children and families in your community?            No more than 150 words
7. Please provide any additional information about your professional practice as it relates to the mission of AFCC. AFCC’s mission statement can be found at www.afccnet.org/about/mission.asp.            No more than 150 words
8. AFCC strives for diversity among colleagues, professions and services. Our collective differences enhance the work of AFCC by providing many different perspectives. Diversity includes, but it is not limited to: age, color, ethnicity, gender, geographic region, national origin, disability, race, religion, sexual orientation and socio-economic background. How could you bring diversity to the association?            No more than 150 words
References
In the space provided below, please provide one professional reference from your community, including name, professional designation, address, phone and fax numbers and email address.