Vivian Roy Bowser Cancer Education Fund Scholarship Form

VRB
GRANT AND SCHOLARSHIP FORM

Note to scholarship
applicants: Advocacy Scholarships are intended to defray the cost
of transportation and lodging for NEA Members enrolled in the National
Breast Cancer Coalition’s NBCC PROJECT LEAD COURSE. Proof of registration
(such as a photocopy of your Project LEAD acceptance/registration
letter) must be submitted with this application to be conisidered
for this scholarship. And although there are no deadlines for submitting
application, NEA HIN recommends that you submit your request as
soon as you have received enrollment confirmation.

Note to Grant
Applicants: While programs funded through this program may be coordinated
by NEA members or staff, any funding must be awarded through an
Association with a designated financial officer. Please contact
NEA HIN (link to aol address) if you have any questions about his
application or funding.

To apply for
a VRB Cancer Education Fund Local Grant or Advocacy Scholarship,
please complete the following information and submit your application
online, or print and mail to:

NEA HIN
VRB Grant & Scholarship Program
1201 16th Street, NW, Suite 521
Washington, DC 20036

Amount Requested

Association Name:

Association Financial Contact & Phone Number:

Local Coordinator Name & Occupation:

Local Coordinator Mailing Address, Day Phone and Email:

Please provide
a brief description of your Association’s previous efforts to
educate members about cancer and early detection or other health
issues.

Please provide
a brief description of the project/event this grant will fund.

Who is your intended target audience for this project/event?
(Such as minorities, women, retired school employees, etc.).

How will this grant be used? (Such as speaker travel materials,
room rental, etc.).

If your expenses exceed any awarded grant funding, how will they
be funded? (Local business grants, private donations, school or
Association funds, etc.)

Scholarship
Applicants Please Provide The Following Information:

Date & Location
Of Project Lead Course:

Are You Applying For A Scholarship Through The Nbcc?

No.

Yes.

Your Name
& Occupation:

Your Mailing Address, Day Phone, And Email:

Your Local Or State Association Name:

Please describe your travel needs for this event, such as airfare,
car mileage, lodging expenses, etc.

If your expenses exceed any awarded scholarship funding, how will
you cover these expenses, such as personal funds, local business
grants, school or Association funds, etc.

Please
provide a brief description of your local, state, or national
involvement in cancer education efforts.

How do you intend to use the information you learn at the Project
LEAD course to benefit your Association and other NEA members?