Scholarship Application

WE ARE NO LONGER ACCEPTING SCHOLARSHIP APPLICATIONS AS ALL AVAILABLE FUNDS HAVE BEEN EXHAUSTED.

Applications submitted on January 8, 2009 or later will not be accepted or processed.

Living Beyond Breast Cancer, Susan G. Komen for the Cure and the Young Survival Coalition will provide a limited number of travel scholarships to our annual conference. Minority and underserved women are encouraged to apply.

YOU WILL KNOW THAT YOU HAVE SUCCESSFULLY SUBMITTED YOUR SCHOLARSHIP APPLICATION WHEN YOU SEE THE "GREETINGS FROM TEXAS" POSTCARD. IF THIS DOES NOT APPEAR, RE-CHECK THE APPLICATION FORM AND COMPLETE THE SECTIONS IN RED.

ELIGIBILITY CRITERIA

• Applicants with a demonstrated financial need who, otherwise, would be unable to participate in the 9th Annual Conference for Young Women Affected by Breast Cancer, and who have not received a travel scholarship in the past two consecutive years, 2007 and 2008.
• Priority will be given to applicants with breast cancer.
• Applicants must agree to use the funds to attend the full conference and will be required to sign in and sign out at the Scholarship Registration table.
• Applicants must show a current, valid photo ID at scholarship registration. Acceptable forms of photo identification include: driver's license or state issued ID card or passport.
• Applicants must agree to complete the conference evaluation forms, turn them in at the conclusion of the conference and provide a brief testimonial statement that informs LBBC, Susan G. Komen for the Cure and YSC of the impact the conference had on the applicant. By applying and accepting the scholarship, recipient agrees that testimonials may be used on the conference website or in future marketing materials.
• Applicants must check out at the Scholarship Registration table and return evaluations at the conclusion of the conference to receive scholarship reimbursement forms.
• All information provided must be accurate. Any information not valid will result in the immediate termination of your scholarship.

GENERAL INFORMATION

• Completed applications should be submitted online using the online application form below.
• Completed scholarships must be received no later than February 20, 2009.
• There is a maximum limit to the amount of scholarships this year:
  • $600 for continental US residents
  • $900 for Canada, Puerto Rico, Mexico, Alaska and Hawaii residents
  • $2,100 for International residents
• The scholarship funds are provided to help cover airfare, train, bus or car transportation; a maximum of up to two hotel nights for continental US residents and up to three nights for Canada and other international residents (50% of the room rate for each night at the Hilton Anatole hotel); 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.
• Scholarship recipients must reserve a room at the conference hotel, Hilton Anatole, and share a hotel room or pay the cost difference for a single room. Cost is the same for single/double occupancy. Obtaining a roommate is the responsibility of the recipient. To help you connect with other conference attendees who seek a roommate, please visit the 9th Annual Young Survivors Conference Message Board.
• Individual scholarship recipients must check in and out at the Scholarship Registration table at the beginning and end of the conference and present their current, valid photo ID. Checking in/out others is NOT permissible. No exceptions.
• Registration for the conference confirms your acceptance of the scholarship. You must register online or by phone at 610.645.4567 within seven (7) days of being notified you received a scholarship or your award may be given to another applicant. 
• Please note if you are approved for a scholarship and you decide not to attend the conference or no longer need the scholarship funds, we request that you email scholarships@iplanitmeetings.com as soon as possible so the funds can be transferred to another applicant.
• Expenses that will not be reimbursed include: transportation to and from the airport, meals, rental cars, parking and additional hotel charges such as phone, Internet, in-room movies, laundry, gift shop purchases, room service.
• Canadian and other International applicants must calculate all 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/
• All applicants must briefly describe their financial circumstances and their need for a conference scholarship.

• Reimbursement will be made upon receipt of all travel expense receipts submitted after the conference. All travel scholarship reimbursement requests must be received no later than March 31, 2009 to be processed. Applicants from the United States, Puerto Rico and Canada should forward their reimbursement request to LBBC. All International applicants should forward their reimbursement request to YSC.  Reimbursement for the amount requested might not necessarily be the total amount received. Reimbursement checks are made only to the scholarship recipient and may not be made out to another individual. Any reimbursement request received after March 31, 2009 will not be processed.

NOTIFICATION PROCESS

All applicants will be notified by email, phone or fax within two weeks from the date the completed application was submitted.  All scholarship recipients must register for the conference within seven (7) 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 email scholarships@iplanitmeetings.com.

PERSONAL INFORMATION NOTE: A separate application form is required for each person with expenses. *indicates required field. First Name*:   Last Name*:   Organization (if applicable):   I am connected with one of the YSC affiliates:  Atlanta, GA    Columbus, OH    Detroit, MI    Duluth, MN    Houston, TX    Indianapolis, IN    Kansas City, KS    Miami, FL    Northern California    Northern New Jersey    Orlando, FL    Philadelphia, PA    San Diego, CA    Savannah, GA    Tulsa, OK    Washington, DC    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: EXPECTED EXPENSES Please include only those expenses for which you require financial assistance. I need financial assistance to cover my primary transportation method to the conference*:  Yes  No If yes, please select the form of transportation you will be using:  Airfare    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/Komen/YSC 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 have negotiated discounts with several airlines. Click here for airline discount information. We reserve the right to adjust your scholarship request based on reasonable roundtrip fares between your departure airport/train station and the metropolitan Dallas area. If traveling by air or train, please specify your hometown airport/train station:   A room block as been secured at the Hilton Anatole at a reduced rate of $156+tax per night [total=$179.40]. Recipients will only be reimbursed for 50% of this room block rate. Scholarship recipients must share a hotel room or pay the cost difference for a single room. Reimbursement is available for up to a maximum of 2 nights for continental U.S. residents; 3 nights for Canada, Puerto Rico, Alaska, Hawaii and other International residents. 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 room block name "9th Annual Conference for Young Women Affected by Breast Cancer." Click here for more information on how to reserve your room. Cost of hotel to be included in your scholarship request for accomodations at the Hilton Anatole: Tax included in all rates.  $90 (50% for one night)  $180 (50% for two nights)  $270 (50% for three nights-Canada, Puerto Rico, Mexico, Alaska, Hawaii and International residents only)  I do not require financial assistance with hotel costs. Please read the General Information section (above) to review the eligibility criteria and related information for the 2009 scholarships. Maximum award amounts: $600 for continential U.S. residents; $900 for Canada, Puerto Rico, Mexico, Alaska and Hawaii residents; $2,100 for International residents Cost of the registration fee to be included in your scholarship request*:  $135 (conference fee)  $50 (student conference fee)  I do not require financial assistance to cover the registration fee. 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 register to attend the conference separately and within seven (7) days of being notified that I have received a scholarship. After seven days my award may go back into the scholarship fund and may be reallocated to another applicant.  Yes I understand that...* I am responsible for making my own hotel reservations in the 9th Annual Conference for Young Women Affected by Breast Cancer room block at the Hilton Anatole (toll-free phone # 1.800.HILTONS or click here.  Yes I understand that...* scholarship recipients must stay at the Hilton Anatole 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...* LBBC/Komen/YSC may adjust my scholarship amount without notifying me if the requested amount exceeds maximum allowances.  Yes I understand that...* LBBC/Komen/YSC may adjust my requested transportation amount based on reasonable roundtrip fares between my departure airport/train station and the metropolitan Dallas area.  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 check in at the beginning of the conference at the Scholarship Registration table using a current, valid photo ID.  Yes I understand that...* I must check out using a current, valid photo ID at the conclusion of the conference and return my evaluation forms at the Scholarship Registration table to receive my scholarship reimbursement form.  Yes I understand that...* I must submit receipts with my reimbursement form for all expenses. Reimbursement requests received after March 31, 2009 will not be processed.  Yes 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.  Yes I verify that...* all submitted information is accurate and valid.  Yes

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

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YOU WILL KNOW THAT YOU HAVE SUCCESSFULLY SUBMITTED YOUR SCHOLARSHIP APPLICATION WHEN YOU SEE THE "GREETINGS FROM TEXAS" POSTCARD. IF THIS DOES NOT APPEAR, RE-CHECK THE APPLICATION FORM AND COMPLETE THE SECTIONS IN RED.

If this symbol appears at the top of the form once you press the submit button, 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.