Living Beyond Breast Cancer Scholarship Application
Conference for Women Living With Advanced Breast Cancer
Enhancing Your Health and Quality of Life
Saturday, May 3, 2008

Philadelphia Marriott West
111 Crawford Avenue, West Conshohocken, PA 19428

 

Living Beyond Breast Cancer will provide a VERY LIMITED number of travel scholarships to our advanced breast cancer conference. Applications will be reviewed on a rolling basis until funds are depleted. Please do not delay - submit your application as soon as possible.

WE ARE NO LONGER ACCEPTING SCHOLARSHIP APPLICATIONS FOR THIS CONFERENCE.

Eligibility Criteria

• Applicants with a demonstrated financial need who, otherwise, would be unable to participate in LBBC's May 3, 2008 conference.
• Priority will be given to applicants with advanced breast cancer.
• Scholarships for this conference are open to people living in the United States and Canada.
• Applicants must agree to use the funds to attend the full conference.
• Applicants must agree to complete conference evaluation forms and provide a brief testimonial statement that informs LBBC of the impact the conference had on the applicant. By applying and accepting the scholarship, recipient agrees that testimonials may be used on LBBC's website or in future marketing materials.

General Information

Completed applications should be submitted online using the form below.

• There is a maximum limit to the amount of scholarships this year:
  • $500 for continental United States residents
  • $800 for Alaska, Hawaii and Canada residents
• The scholarship funds are provided to help cover airfare, train, bus or car transportation; a maximum of up to two hotel nights (50% of the room rate for each night at the Philadelphia Marriott West); and/or the conference registration fee.
• Scholarship funds awarded may or may not cover all expenses. Cancellation of your flight for any reason is not our responsibility.
• Expenses that will not be reimbursed include: transportation to and from the airport, meals, rental cars, parking, and additional hotel charges such as phone, in-room movies, Internet access, laundry, gift shop purchases, room service.
• Scholarship recipients must reserve a room at the conference hotel, Philadelphia Marriott West, and share a hotel room or pay the cost difference for a single room. Cost is the same for single/double occupancy. Recipients will only be reimbursed for 50% of the room rate for a maximum of two nights. Obtaining a roommate is the responsibility of the recipient. LBBC's Our Corner Message Board can help you connect with other conference attendees. Please visit http://www.lbbc.org/forum/login.asp to register and post messages on the Advanced Breast Cancer Conference 2008 topic.
• A small room block has been secured at the Philadelphia Marriott West at a special reduced rate of $129+tax per night. You must make your own reservations. Please reference the Living Beyond Breast Cancer conference to obtain the reduced rate.
• Canadian applicants must calculate their expenses in US dollars. All funds will be reimbursed in US dollars. Please visit this site to assist you in your conversion: http://www.xe.com/ucc/.
• Registration for the conference confirms your acceptance of the scholarship. You must register online at http://www.lbbc.kintera.org/may08conf or by phone at 610.645.4567 within five (5) days of being notified you received a scholarship or your award may be given to another applicant.
• Reimbursement will be made upon receipt of all travel expense receipts submitted after the conference. Expenses will not be reimbursed before the conference. All travel scholarship reimbursement requests must be received in the LBBC office no later than June 6, 2008 to be processed. Reimbursement for the amount requested might not necessarily be the total amount received. Any reimbursement requests received after June 6th will not be reimbursed.
• Scholarship recipients must check in at registration at the beginning of the conference.

Note: If you are approved for a scholarship and you decide not to attend the conference, we request that you contact Lisa at lisa@lbbc.org as soon as possible so that funds can be transferred to another applicant.

Notification Process

All applicants will be notified by email, phone or fax within 7 business days from the date the completed application was received. All scholarship recipients must register for the conference within five days of notification of award or the scholarship will go back into the fund and may be given to another person. 

If you have any questions, please contact Lisa at lisa@lbbc.org.

PERSONAL INFORMATION NOTE: A separate application form is required for each person with expenses. *indicates required field. First Name*:   Last Name*:   Organization (if applicable):   Address*:   City*:   State*: (International use XX)   Zip Code*:   Province (if applicable):   Country:   Email Address*:   Please re-type your email address*:   Home Phone*:   Work Phone:   Year of birth:   Race/Ethnicity:  African American  White, not Hispanic or Latino  Asian  Hispanic or Latino  Native American  Mixed Background  Pacific Islander  Other Do you identify yourself as a: (check all that apply)  Woman who has been diagnosed with breast cancer  Woman affected by breast cancer  Caregiver, family member, friend  Health professional Year of breast cancer diagnosis, if applicable:   If you have had breast cancer, do you have advanced (metastatic) breast cancer?  Yes  No If you have advanced breast cancer, please indicate your year of this diagnosis:   If you have not had breast cancer, please explain your interest in attending this conference: EXPENSES Please include only those expenses for which you require assistance. If you can pay some of your expenses, please subtract that amount and only ask for the amount you need help with. I need financial assistance to cover my primary transportation method to the conference.*  Yes  No If yes, please select which form of transportation you will be using:  Airplane  Train  Bus  Car (gas receipts required) Indicate the cost of your primary method of transportation to be included in your scholarship request*: If you do not require assistance, please write $0.   LBBC will reimburse no more than the actual cost for the most economical, non-refundable economy airfare/train fare. Please research the best method of transportation and competitive fares. We reserve the right to adjust your scholarship request based on reasonable roundtrip fares between your departure airport/train station and the metropolitan Philadelphia area. If traveling by air or train, please specify your hometown airport/train station:   A room block has been secured at the Philadelphia Marriott West at a reduced rate of $129+tax per night [total=$139.32]. Recipients will only be reimbursed for 50% of the room block rate. Scholarship recipients must share a hotel room or pay the cost difference for a single room. Rooms are available for a maximum of 2 nights. If you are sharing a room with someone who needs a scholarship to cover their 50% of the hotel room costs, they must submit a separate scholarship application. You are responsible for making your own hotel reservations using the block name of "Living Beyond Breast Cancer Conference" and securing a roommate using the LBBC Our Corner Message Board. Cost of hotel to be included in your scholarship request for accommodations at the Philadelphia Marriott West*:  $70 (50% for one night)  $139 (50% for two nights)  I do not require financial assistance with hotel costs. Cost of registration fee to be included in your scholarship request*:  $35 (conference fee)  I do not require financial assistance to cover the registration fee. Please read the General Information section (above) to review the eligibility criteria and related information for the 2008 scholarships. Maximum award amounts: $500 for continental United States residents; $800 for Alaska, Hawaii and Canada residents. TOTAL AMOUNT OF SCHOLARSHIP REQUEST*:   Please briefly describe your financial circumstances and your need for a conference scholarship. How will you utilize the information you learn at this conference in your community?* PLEASE ANSWER THESE QUESTIONS TO HELP US SERVE YOU BETTER. I understand that...* I must agree to attend the full conference.  Yes I understand that...* I must register to attend the conference separately and within five (5) days of being notified that I have received a scholarship. After 5 days my award may go back into the scholarship fund and may be transferred to another applicant.  Yes I understand that...* I am responsible for making my own hotel reservations in the Living Beyond Breast Cancer Conference room block at the Philadelphia Marriott West (1-800-237-3629). Scholarship recipients must stay at the Philadelphia Marriott West to receive reimbursement of hotel expenses.  Yes I understand that...* I must share a hotel room or pay the cost difference for a single room.  Yes I understand that...* I may not receive the entire scholarship amount requested based on funds available, demonstrated need or maximum limit allowed.  Yes I understand that...* I must submit receipts with my reimbursement form for all eligible expenses to be received no later than June 6, 2008 to receive reimbursement.  Yes I understand that...* I understand that scholarship funds will not be awarded prior to or during the conference for any reason. All scholarship funds will be distributed after the conference and only after receipts and supplied reimbursement forms are submitted to LBBC.  Yes I understand that...* I understand that I must check in at registration at the beginning of the conference.  Yes

NOTE: If you have spam protection on your email account, please add lisa@lbbc.org to your address book or check your spam folder for a reply to your request.

You will know you have successfully submitted your scholarship application when you see a picture of a butterfly in purple flowers. If this does not appear, re-check the application form and complete the sections in bold print.

If this symbol appears at the top of the page once you submit your form, it means there has been at least one error.  Please review the form, especially the required fields, to make sure that your form is complete and resubmit.