Scholarship Application Sonsored by the PA Commission on Crime and Delinquency. Please enter your information. Name * Name First Name First Name Last Name Last Name Email * Company * Address * Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal County * Applicant Agency/Coalition Description * Single County Authority Prevention Provider Communities that Care Coalition Drug Free Communities Coalition Other Community Prevention Coalition Treatment/Recovery/Harm Reduction Field Institute of Higher Education School District College Student Faith Based Organization Community Member/Advocate For Profit Business OtherOther Does your organization or coalition currently receive PCCD funding? * Yes No Please provide a brief financial statement of need. * 0 of 40 max words How will attending the conference benefit your prevention efforts? * 0 of 40 max words Do you reside or work 50 or more miles from the Penn Stater Hotel and Conference Center? * Yes — By selecting this option, you certify that this information is accurate and acknowledge that you will receive three nights of lodging (June 10-12). No — You do not qualify for lodging support. By checking the box below, I agree to the scholarship application guidelines and agree with the eligibility, requirements, attendance, terms and conditions, and cancellation policy of receiving a scholarship? * Yes, I agree. Submit Your Application If you are human, leave this field blank. Full Conference Details
