Parent Scholarship Information Parent Scholarship
2015 PA PBIS Implementers’ Forum May 27-28, 2015 Hershey Lodge and Convention Center, Hershey, PA
Parent Scholarship Information The Bureau of Special Education and PaTTAN are pleased to offer parent scholarships to Pennsylvania residents who are not employed in a professional capacity by a school entity. Parents can apply for either a partial scholarship (registration fee only) or a full scholarship (registration and lodging for those who live beyond 50 miles of the Hershey Lodge and Convention Center). All scholarship applications must be email dated or postmarked on or before April 10, 2015 and sent to Kristen Olszyk via email [email protected] or 3190 William Pitt Way, Pgh., PA. 15238.
Parent Scholarship Application Please provide the following information to apply for a parent scholarship : Name: Home Address:
City:
Daytime Phone:
Alternate Phone:
Employer:
Work Phone:
Zip:
Email (primary mode of communication from PaTTAN): My child has an IEP/IFSP:
YES
NO
My child’s age is:
Check your child’s disability category (if applicable): Autism Deaf or Hard of Hearing Deafblindness Emotional Disturbance
Intellectual Disability Multiple Disabilities Orthopedic Impairment Other Health Impairment
Specific Learning Disability Speech and Language Impairment Traumatic Brain Injury Visual Impairment including Blindness
Child’s Name: Child’s Date of Birth: School District: Child’s School: Partial Scholarship (registration fee waived): I am a parent who lives within 50 miles of the Hershey Lodge. Full Scholarship (registration and lodging fees waived): I am a parent who lives beyond 50 miles of the Hershey Lodge. I will need lodging for the following evening(s): Tuesday, May 26, 2015
Wednesday, May 27, 2015 Parent Scholarship Application
Parent Scholarship Application continued Upon approval of your scholarship, you will be responsible for arranging your lodging at the Hershey Lodge. You must provide valid credit card information to guarantee your room. Your card will not be charged unless you cannot attend the forum and do not cancel your room by contacting, Kristen Olszyk at [email protected] or 800.446.5607 ext. 6848 by May 8, 2015. If you do not cancel your hotel room, your credit card will be billed. A single room will be provided for each full parent scholarship recipient. You can either email your parent scholarship application to: [email protected] or mail it to: Kristen Olszyk, PaTTAN Pittsburgh, 3190 William Pitt Way, Pittsburgh, PA 15238. Applications must be email dated or postmarked on or before April 10, 2015. You will receive an email confirmation when your scholarship request is received. Scholarship approvals with additional information will be emailed. For additional information contact: Kristen Olszyk at 1.800.446.5607 ext. 6848 or via email [email protected]. Register for forum sessions online at: www.pattan.net. (Select PAPBS Implementers’ Forum on Training Tab.)
Parent Scholarship Application
Parent Scholarship Information The Bureau of Special Education and PaTTAN are pleased to offer parent scholarships to Pennsylvania residents who are not employed in a professional capacity by a school entity. Parents can apply for either a partial scholarship (registration fee only) or a full scholarship (registration and lodging for those who live beyond 50 miles of the Hershey Lodge and Convention Center). All scholarship applications must be email dated or postmarked on or before April 10, 2015 and sent to Kristen Olszyk via email [email protected] or 3190 William Pitt Way, Pgh., PA. 15238.
Parent Scholarship Application Please provide the following information to apply for a parent scholarship : Name: Home Address:
City:
Daytime Phone:
Alternate Phone:
Employer:
Work Phone:
Zip:
Email (primary mode of communication from PaTTAN): My child has an IEP/IFSP:
YES
NO
My child’s age is:
Check your child’s disability category (if applicable): Autism Deaf or Hard of Hearing Deafblindness Emotional Disturbance
Intellectual Disability Multiple Disabilities Orthopedic Impairment Other Health Impairment
Specific Learning Disability Speech and Language Impairment Traumatic Brain Injury Visual Impairment including Blindness
Child’s Name: Child’s Date of Birth: School District: Child’s School: Partial Scholarship (registration fee waived): I am a parent who lives within 50 miles of the Hershey Lodge. Full Scholarship (registration and lodging fees waived): I am a parent who lives beyond 50 miles of the Hershey Lodge. I will need lodging for the following evening(s): Tuesday, May 26, 2015
Wednesday, May 27, 2015 Parent Scholarship Application
Parent Scholarship Application continued Upon approval of your scholarship, you will be responsible for arranging your lodging at the Hershey Lodge. You must provide valid credit card information to guarantee your room. Your card will not be charged unless you cannot attend the forum and do not cancel your room by contacting, Kristen Olszyk at [email protected] or 800.446.5607 ext. 6848 by May 8, 2015. If you do not cancel your hotel room, your credit card will be billed. A single room will be provided for each full parent scholarship recipient. You can either email your parent scholarship application to: [email protected] or mail it to: Kristen Olszyk, PaTTAN Pittsburgh, 3190 William Pitt Way, Pittsburgh, PA 15238. Applications must be email dated or postmarked on or before April 10, 2015. You will receive an email confirmation when your scholarship request is received. Scholarship approvals with additional information will be emailed. For additional information contact: Kristen Olszyk at 1.800.446.5607 ext. 6848 or via email [email protected]. Register for forum sessions online at: www.pattan.net. (Select PAPBS Implementers’ Forum on Training Tab.)
Parent Scholarship Application
