Ella Irby Professional Development Scholarship Fund Application

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Ella Irby Professional Development Scholarship Fund Application Form

Name of First Applicant (4+ years of membership)(Required)

First Last

Phone(Required)

Phone Type(Required)

Text

Voice

Email(Required)

Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name of Second Applicant (2+ years of membership)(Required)

First Last

Phone(Required)

Phone Type(Required)

Text

Voice

Email(Required)

Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Conference Title(Required)

Host Organization(s)(Required)

Location(Required)

City State / Province / Region

(Start) Date(s)(Required)

(End) Date (optional)

Statements

Personal Statement: Please tell us why your partnership should be selected as the recipients of this scholarship. What unique offerings do you bring as a pair that will benefit interpreters in our state when you return to provide a workshop for ARID?(Required)

Workshop Goals: Please tell us about the workshop your partnership plans to produce for ARID at the completion of your scholarship project. We understand that this content is subject to change based on your experience at the conference. Please use this as an opportunity to share your thoughts without feeling like you are obligating yourself to a specific topic or approach.(Required)

Applicant #1 Membership/Licensure Information

Please upload all scanned copies of membership and licensure at the bottom.

ARID Current Membership Status:(Required)

ARID Voting Status:(Required)

ARID Number of Years:(Required)

Verify with Membership Chair(Required)

Arkansas Current Licensure Status:(Required)

Arkansas Interpreter License #:

Arkansas Provisional License #:

Applicant #2 Membership/Licensure Information

Pleas upload all scanned copies of membership and licensure at the bottom.