Conference Scholarship Application

MACC will provide a number of full need-based scholarships for health and human services providers, consumers (of behavioral health services), consumer family members and/or and students. The scholarship will cover the conference registration fee.

Applications will be reviewed and distributed on a first-come, first-served basis. 

In order to apply, please fill out the below form. Someone will be in contact with you within 48 hours to confirm receipt.

Section 1: Applicant information
Name *
Name
Please list any organization(s) you are affiliated with.
Phone *
Phone
Address *
Address
This information is used for reporting purposes only.
This information is used for reporting purposes only and will not be taken into consideration as part your scholarship application. If you do not wish to self-identify, please write N/A.
This information is used for reporting purposes only and will not be taken into consideration as part your scholarship application.
Section 2: Application Questions
Group Affiliation *
Please select all that apply.