LIFE Conference XII 
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Scholarship Application

Scholarship Application Form
LIFE Conference Scholarship Application

The LIFE Conference offers a limited number of scholarships to consumers and parents of children with disabilities.  The registration fee is waived for those receiving a scholarship.  Scholarships are awarded to the first 20 applicants based on their financial need. You must apply for a scholarship before you register.
To apply for a scholarship, complete the form below and click on the 'Submit' button.  You will be verified by email of your scholarship status.
First Name:
Last Name:
Address Street 1:
Address Street 2:
City:
Zip Code: (5 digits)
State:
Daytime Phone:
Evening Phone:
Email:
Type of Scholarship
Reason for Scholarship Request:

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