Scholarship Application 2023

There are limited scholarships for HI families needing financial support and traveling from out of town to stay at the hotel the nights of April 14 and 15 while attending the conference. Families interested in these scholarships should indicate this on their registration form and fill out the application form below (All information provided in this application will be held in the strictest confidence). Please send an email to jschmitt@congenitalhi.org if you have questions.

The deadline for this scholarhip application is March 1, 2023. If awarded a scholarship, CHI will reserve the rooms for these families.

    Date:

    Your Name

    Address:

    Mobile phone number:

    Email

    Names of people in addition to you in your family attending the conference. Please include children and their ages:

    Please state in 200 words or less your reason for seeking this scholarship. Please state your financial need.

    Please state in 200 words or less what you hope to gain by attending the conference.

    Please authenticate your form submission:

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