Scholarship Application for NCDD Seattle

1. General questions

If you are unable to cover the full registration costs associated with attending the 2012 NCDD conference, please submit this 12-question application as soon as you are able to.

Please only apply for the assistance you need so we can support as many people as possible with our limited scholarship funds. Note that scholarships are for new registrants only. We cannot apply scholarships to registrations that have already been paid.

NEW NOTE ADDED 10/1/12: Email sandy@ncdd.org to let us know you've applied for a scholarship! With so many final tasks, we're not checking new scholarship applications often. Applications submitted after October 4th will not be considered.

Question Title

* 1. Your Contact Information

Name: *

Organization and Title:

City: *

State:

Country (if not U.S.):

Email Address: *

Phone Number: *

Question Title

* 2. Are you a member of NCDD?

Yes - I'm a supporting, sustaining, or organizational member

Yes - I'm a member (non-dues-paying)

I'm not sure

Question Title

* 3. Which, if any, previous NCDD conferences have you attended?

None - this will be my first NCDD conference

One of NCDD's 2010 regional events (Portland, Austin, Boston, Cupertino or Denver)

NCDD 2008 in Austin

NCDD 2006 in San Francisco

NCDD 2004 in Denver

NCDD 2002 in Washington, DC

If you HAVE attended previous NCDD conferences, did you receive scholarship support?

Question Title

* 4. Please briefly describe your involvement in dialogue and deliberation and why you'd like to attend the NCDD conference. Also let us know here if you're already set to play a role at this year's conference.

Be sure to continue onto the next page of the survey to answer a few demographic questions and then to the final page to specify the level of support you're seeking.

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