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ADA Conference 2019-Putting the Pieces Together
“Driving the Future of the ADA”
Otis Reed Memorial Scholarship Application
April 14th-16th, 2019
Applicant Name: ________________________________________________________
Organization: ___________________________________________________________
Address: _______________________________________________________________
City, State & Zip: ________________________________________________________
Phone: _______________________________ Fax: _____________________________
Email: _________________________________________________________________
Application Date: _________________________
Scholarship Criteria:
Applications will be reviewed and prioritized based on the following criteria:
Applicants who are new to their position and deal with ADA client transportation, eligibility or other transportation issues;
Attendees who work in paratransit and have not previously attended an ADA Issues & Resolutions Conference;
Applicants whose agency would not be sending anyone due to budgetary cuts.
The number of scholarships awarded will be dependent upon the amount available and funding appropriated for scholarships. Scholarships will cover the Conference Registration fee and $100.00, to be
used toward expenses to attend the conference.
Return to: Deborah Paine, Fax: 509-664-4095 or email [email protected].
What is your current title or job description? _____________________________________________
How long have you been in this position? _______________________________________________
What are your job duties? ___________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
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Page 2: Otis Reed Memorial Scholarship Application, April 14th-16th, 2019
Explain how your attendance at this ADA Conference will benefit your agency and your agency’s financial need. _____________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
I pledge to attend all Conference sessions and will report back to my organization(s) regarding information I receive. I understand that if I am awarded a scholarship and fail to meet my obligations of Conference attendance/participation that my employer or I will be billed by the Conference organizers for repayment of the scholarship amount.
Applicant Signature ___________________________________ Date __________________
Estimated Cost
Estimated Categories Estimated Expenses
Travel: Car-Round-Trip mileage _________x $0 .58*
(*2019 actual rate.)
: Airfare- Round-Trip
Lodging: (Current rate plus tax) x number of nights
Conference Registration Fee Waived $0.00
Total
Applications must be in by March 1, 2019. Notifications will be make on or before March 8th.
Return to: Deborah Paine, Fax: 509-664-4095 or email [email protected].
For information regarding other Washington State Rural Transit Assistance Program Scholarships (RTAP) for this event, please contact Linda Howell- WSDOT Public Transportation Division, State
RTAP Manager, (253) 651-5466 or [email protected].
http://www.wsdot.wa.gov/transit/training
