Alaska Breastfeeding Coalition Scholarship Application Form
The Alaska Breastfeeding Coalition (ABC) scholarship was established to further the goals of the ABC and to
provide financial assistance for members (who could not otherwise afford it) to attend the ABC annual
conference. To apply for the scholarship, you must be an Alaska Breastfeeding Coalition member, and you must
live and work in Alaska.
Application and Selection Process
1. Applications must be received by the stated deadline; February 15, 2017, for the April 2017 conference.
Late applications will not be accepted. Applications will be acknowledged when received via email:
mailto:[email protected]. We prefer that you type your application in this document,
but if you prefer to fill it in by hand please print legibly and sign by hand rather than electronically.
2. The Alaska Breastfeeding Coalition (ABC) Scholarship Committee will review all applications and
select recipients based upon set criteria.
3. All applicants for the ABC scholarship will be notified of the decision of the committee no later than
March 1st of 2017.
4. Recipients of the scholarship must attend the conference in the year in which the scholarship is awarded.
Scholarships are not transferrable.
5. Awarded monies are not meant to cover the entirety of the expenses which may be incurred by an
attendee, but only to assist in making attendance more affordable for members in need, who might
otherwise not be able to attend.
I. Please complete the following application information:
Mailing Address:__________________________________________________________
City: __________________________________________________________ , Alaska
Zip Code: __________________________________________
Best telephone number: _____________________
Home
Cell
Work
(Indicate one)
Are you a member of the Alaska Breastfeeding Coalition? Yes
No
Since ______
Have you ever attended the ABC annual conference or other education seminars? Yes
No
If yes, when and how many times?
The Alaska Breastfeeding Coalition wishes to promote diversity, so please circle one or more
which best describe your ethnicity, or you may add a description if you prefer:
Alaska Native
Black/African American
Native Hawaiian/Pacific Islander
American Indian
Caucasian
Other:
Asian
Hispanic/Latino
II.
Please answer the following questions as completely but concisely as possible.
If you need additional space, please include a typed PDF of your answers.
a. Provide a description of both your past and your present job(s) or volunteer position(s).
Include your roles as leader, your involvement in breastfeeding related activities
(including length of involvement), and goals.
b. Please provide your reason(s) for applying for the scholarship. Do you receive any
financial assistance for attending conferences/seminars or continuing medical education
funds from your institution? Estimate your expenditures in attending the conference.
Please describe this in some detail.
c. Describe your involvement with ABC, your local coalition, or workplace (or other)
breastfeeding support committee; include length of involvement with organizations.
d. Explain how attendance at this conference will benefit you and your work (such as
professional goals), and how you hope to apply the knowledge gained.
e. How do you plan to share your experiences with others? What population(s) do you
work with, and where?
III.
Please initial the following statements, and sign the form electronically prior to
submission:
_____ By completing and signing this application, I am attesting that the statements I have
made are true. If I am awarded the scholarship, I agree to register for and attend the conference
in the same year or repay any monies paid by the ABC on my behalf.
_____ I hereby give my permission to the ABC Scholarship Committee members to make
further inquiries and/or to request my attendance via telephone to answer further questions they
may have in relation to my application.
Signed:
Date: