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SC Autism Society's 2008 Workshops

SCHOLARSHIP APPLICATION

* All Fields Required.
* Your Name
* Your Address 1
Your Address 2
* Your City    * State       * Zip Code   
* Phone Please include area code.
* Your E-mail (Any changes will be sent by email.)

Parent of a child with autism?

YES

NO

 *****

YES

NO

Choose
Sessions

Session Name

Location

Date

Deadline for
Requests

# of Scholarships Requested

(1 or 2)

Name of 2nd Scholarship Recipient

(if requested)

Inclusion

Columbia

06/12/08

06/07/08

I am a parent of a child with an ASD who is requesting a scholarship for the above-referenced workshop(s). I understand that the scholarships for parents offered by SCAS are to attend the Workshops I have indicated above. There are a limited number of scholarships offered statewide. Scholarships do not include hotel or travel expenses. If I am awarded a scholarship and do not attend the workshop without notice to SCAS, I will be charged the full registration price.

By typing my initials here, I indicate request for scholarship(s) above (in lieu of signature)

Due to our website renovation, online registration is unavailable.
You may print the information and mail it to the address below or fax it to 803-750-8121.
You may also call our office, 803-750-6988 OR 800-438-4790, extension 109, and leave a voicemail with registration information requested above. Please be sure to include the seminar name and a contact phone number if you choose this option.


South Carolina Autism Society ♦ 806 12th Street ♦ West Columbia, South Carolina 29169 ♦ 803-750-6988