Conference Scholarship - Don’t Export

2021 Child & Adolescent

Mental Health Conference

April 18-20, 2021 |Virtual

Scholarships are available to parents & caregivers of children with mental health disorders and will be selected at random and notified mid-March. Please note that if you are awarded a scholarship a certificate of attendance will be issued for your participation in place of a continuing education certificate.

To be considered for a conference scholarship, please fill in the information below as completely and accurately as possible by Monday, March 22nd. Recipients will be notified by Monday, March 29th if they have been awarded a scholarship.

Please note: Funding has not yet been acquired for conference scholarships. By filling in this form, you are being added to a waitlist for funding as it becomes available.

Feel free to email rjacques@macmh.org if you have any questions.

First Name *

Last Name *

Email: a confirmation of application will be sent to this email, please double check your entry. * 🛈

Address *

This address is my: *

Home

Work

City *

State *

Zip *

County (Please choose "other" if you are not in MN) *

Primary Phone * 🛈

This is my:

Home

Work

Cell

Do you have a child or children with a mental health disorder? *

Yes

No

How old is/are your child or children? *

Have you ever received a scholarship to attend the MACMH conference? *

Yes

No

We are committed to including attendees whose identities reflect all communities throughout Minnesota and beyond.

As part of that commitment and our desire to not mis-identify anyone, are you comfortable listing your race and pronouns?
If so, please list here:

Pronouns

Optional: Would you like to provide any other clarifying information?

I would like to attend:
Please check all that apply
*

Sunday

Monday

Tuesday

Are you able to access partial funding from another source?
(Such as Hennepin County Parent Catalyst Leadership Group, Local or State Advisory Council, or a place of work) *

Yes

No

If selected for a scholarship you will be asked to fill out a conference registration form - a link to the online form or paper registration form will be provided to you via email.

Deborah Saxhaug
Executive Director
Minnesota Association for Children's Mental Health