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CHILD ABUSE AND NEGLECT DISABILITY OUTREACH PROJECT

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PREVENTING ABUSE OF CHILDREN WITH DISABILITIES

We Can Do It!

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A PROJECT OF ARC RIVERSIDE

ARC Riverside

FUNDED IN PART by the Office for Victims of Crime, Office of Justice Programs, with the U.S. Department of Justice

Riverside Conference on Abuse and Disability

This is the 10th National and 3rd International Conference on the
Abuse of Children and Adults with Disabilities,
coordinated by Nora J. Baladerian, Ph.D.

March 14-16, 2005, Riverside Convention Center, Riverside California

CAN Do! Announcement Program Schedule in Brief Call for Papers Registration Hotel

Application for Scholarship

Available only within the United States. Our scholarship fund is limited to individuals who are truly require support. We will give priority to individuals with disabilities and their caregivers. Provide information in all fields of this form, and submit it. You must use this form to apply.

First Name: Last Name:
Address 1:
Address 2:
City: State: Zip:

Phone:

E-Mail Address:

Briefly describe your work in behalf of victims of abuse and/or people with disabilities.

If you are a volunteer with an agency or board, or employed with an agency serving our population, what was their response when you asked them for support to attend this conference?

Are you personally unable to to pay all of the cost? Have you sought local sources of support, especially for travel, before making this request? How much can you afford to pay, what is your actual cost to attend, and how much support do you need? We will consider your registration fee, your hotel room fee (how many days?) and in rare situations, your travel expenses.

Are you...
A person with a disability?
A family member of a person with a disability?
Neither

If you volunteer for, or are employed by an agency or organization that serves our population, provide the name of the organization, a contact name, phone number, email address, and where the organization is located.

Please describe any special needs you may have to fully participate in our conference.

Thank you very much for your application. We hope this turns out so you can attend. Our funding is very limited, but we will respond, and whatever happens we do hope to see you in Riverside!