2013 National Sexual Assault Conference
National Scholarship Application Form
Scholarships are awarded based on certain requirements and qualifications, as described in the
Conference Scholarship Guidelines. Awards are issued in the form of a check reimbursement, not a
cash advance. The amount of the scholarship is based on your estimated travel expenses to attend
the conference. Please complete this form and return as soon as possible. Scholarships will be
awarded on a first-come, first-serve basis, so early submission of your application is encouraged.
Based on funds available, partial scholarships may be awarded.
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Please review the 2013 National Scholarship Guidelines before you complete this form.
California Rape Crisis Centers and CALCASA Member Rape Prevention Programs are
ineligible for the national scholarship program but can apply through CALCASA’s Conference
Scholarship Program for California Rape Crisis Centers and Rape Prevention Programs.
You must plan on attending the entire conference in order to be eligible for a scholarship.
Partial attendance is not allowed.
Please DO NOT REGISTER ONLINE for the conference until you received the decision about
your scholarship application from CALCASA. If awarded a scholarship, you will be given
instructions on how to register.
Applicant Information:
Applicant’s Full Name:
Name of Agency (if applicable):
Name of Your Direct Supervisor (if applicable):
Contact Phone Number:
Fax Number:
Email address:
Reimbursement check made payable to:
Payment (reimbursement) Mailing address:
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2013 National Sexual Assault Conference
National Scholarship Application Form
1. Please select which scholarship you are applying for:
☐ Scholarship for Survivors of Sexual Violence: I am a survivor of sexual violence and have
been a volunteer or advocate in the service of other victims for at least one (1) year, and would
like to attend the 2013 National Sexual Assault Conference.
☐ Scholarship for Advocates from an Underserved Community: I am a Sexual Assault Advocate
from an underserved community (e.g., communities of color, Native American, LGBTQ, persons
with disabilities, rural, etc.) and would like to attend the 2013 National Sexual Assault Conference.
Which underserved community do you identify with?
☐ Rape Prevention Staff from a Local Program: Priority will be given to staff from local,
community-based organizations.
2. Why do you want to attend the 2013 National Sexual Assault Conference? What do you
hope to gain from the conference?
3. How do you plan on using the information gained or learned from this conference in your
work?
4. Have you ever attended the National Sexual Assault Conference in the past? If yes, which
conferences did you attend?
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2013 National Sexual Assault Conference
National Scholarship Application Form
5. Why are you applying for a scholarship? Please describe your needs.
6. This scholarship fund cannot be used towards the registration fee for the conference and
we have very limited scholarship funds. For approved scholarship recipients, we will offer
the reduced conference registration fee of $425. If you are awarded a partial scholarship,
what is your plan to cover the costs for the registration fee and all other travel costs?
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2013 National Sexual Assault Conference
National Scholarship Application Form
Eligible Items for National Scholarship Reimbursement
Travel Expenses: We ask that participants find the most economical form of travel. Attendance at all
conference sessions is required in order to receive this scholarship. The travel expenses awarded in any
scholarship must adhere to California state government travel guidelines as noted below:
 Airfare or Train fare (must be the most economical form of travel). Baggage fees are not allowed.
 Hotel/Airport parking (non-valet only);
 Airport shuttle or ground travel to/from the hotel (no rental cars, fuel/gas costs, or taxi cab fares
allowed);
 Mileage at $0.555 per mile: Round trip mileage from office to conference site (Google map
documentation will be required for verification purposes)
 Lodging at the Federal Government rate for $125/night plus applicable taxes and fees
(approximately $20). Lodging is only available for attendees whose office is more than 50 miles from
the conference site per California government guidelines.
Items that are NOT Eligible for Reimbursements or Scholarship:
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No rental cars or direct fuel/gasoline expenses are allowed.
No sightseeing, recreational, or non-conference related travel expenses
No food or per diem costs
PLEASE REMEMBER: Receipts are required for all expenses.
** Full scholarships are not guaranteed. Partial scholarships may be awarded.
Approved amounts awarded are non-negotiable. **
Please submit this scholarship application to scholarships@calcasa.org. For questions regarding the
scholarship, please contact the following CALCASA staff:
Katie Donahue, katie@calcasa.org, (916) 446-2520 ext. 304
Reimbursements will be sent out 4-6 weeks after completed reimbursements are received.
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2013 National Sexual Assault Conference
National Scholarship Application Form
Estimated Conference Expenses
Travel Start Time/Date:
Travel End Date/Time:
Estimated
Cost
Approved
Amount
Total
Estimate
Total
Approved
Airfare /Train fare – No baggage fees allowed.
Hotel / Airport Parking:
Receipts required
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# of days ________ x $ ________ /day
Self-parking at the Loews Hollywood Hotel is a maximum of $10.00 per day
(no in and out privileges)
Airport Shuttle / Ground transportation (to and from hotel)
Receipts required
Lodging:
# of nights ______ x $125/night ($125/nightly rate + approx. $20/night in taxes and
fees)
NOTE: Lodging only available for attendees traveling more than 50 miles one
way from their office.
Mileage (round-trip): $0.555 x # of miles _________
Attach a map printout (e.g. Google, MapQuest, etc.) to verify miles to and from
your office.
TOTAL FINAL COST
Recipient submission of Scholarship application:
________________________________________________
Signature
_____________________
Date
END OF APPLICATION – THANK YOU
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