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Conference 2017 Website

A Place at the Table

Scholarship Request Form

If you prefer, you can download the application form and mail it to DignityUSA.  Required fields are marked with a *

Use (XXX) XXX-XXXX format
Please enter the years of any previous DignityUSA conventions you attended. If you haven't attended any in the past, leave this field blank.
Please indicate what religious community you belong to. If you belong to a religious community, you may qualify for scholarships from the Sister Eileen DeLong Scholarship Fund. If you do not belong to a religious community, please leave this field blank.
Briefly describe your current involvement with DignityUSA, and/or a local Chapter and/or a DignityUSA Caucus.
Describe your reasons for wanting to attend this conference.
How do you believe attending the conference will positively affect your involvement in DignityUSA and/or a Chapter or Caucus?
Financial Support Requested
$
If requesting travel support, please describe plans and include projected cost.
$
$
Please detail: number of nights? Willing to share room? If no, why not? Would you need a roommate identified for you?
How do you see yourself giving back to DignityUSA and/or a Chapter or Caucus?
Is there anything else we should know about you in considering your application?