CDPAANYS Lobby Day Scholarship Application

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Please complete the following questions to apply for a Lobby Day Scholarship. All applications will be reviewed anonymously by a committee of CDPAANYS representatives and scored by a common set of standards.

Scholarships include $10 per person (consumer, PA) for lunch and reimbursement of travel expenses to be paid after Lobby Day. Scholarship recipients must submit a reimbursement form and include mileage, tolls and receipts.

Please notify CDPAANYS if you will need help finding an accessible hotel room and/or other reasonable accommodation.

In order to qualify for a scholarship, you must be a CDPA consumer or designated representative with a CDPAANYS Provider Member fiscal intermediary, or be an individual member of CDPAANYS.

Employees of fiscal intermediaries and/or CDPAANYS and Board Directors are not eligible for scholarships.

You must also be transporting yourself to Albany by public transit or your own vehicle.

Scholarships awarded may be partial in nature and will be based on the number of applications received, geographic diversity of applicants, etc. CDPAANYS will make a reasonable effort to accommodate special requests but cannot guarantee full scholarships for all applicants.

CDPAANYS reserves the right to award scholarships in a manner that diversifies the recipient pool based on geography, fiscal intermediary provider, and/or other factors at our sole discretion.

Your Name *

Email Address *

Phone Number *

Fiscal Intermediary *

Do you work for a fiscal intermediary? *

Yes

Are you a Consumer or Designated Representative? *

Consumer

Designated Representative

How long have you been using CDPA? *

Where will you be traveling from? *

How will you be traveling? *

Car/Your own vehicle

Amtrak/Train

Greyhound/Trailways Bus

If your scholarship need can only be partially met, will you still be interested? *

Yes

Why is it important for you to attend Lobby Day? *

What issues affecting CDPA are most important to you, and why? *

Please describe your history with advocacy and activism related to CDPA: *

What previous involvement, if any, do you have with CDPAANYS? *

Please list and describe any CDPA-related advocacy and/or educational events you have attended or participated in: *

Please list and describe any additional activities you believe are relevant to this scholarship application (e.g. community groups, committee boards, etc.): *

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