WV     DHHR     MIS      WVPHA

DHHR Site Search       DHHR Site Map

Application for Retiree Scholarship
to attend the WV Public Health Association Annual Conference
at
Snowshoe Mountain Ski Resort
 September 17 - 19, 2008

The WVPHA awards up to five (5) retiree scholarships to Annual Conference each year.  Scholarship recipients must pay a $30.00 conference registration fee and any applicable section dues and registration fees.  Expenses for meals that are not provided at conference are reimbursable, as is mileage to and from conference.  The mileage rate is $0.445 cents per mile. 

Applicants must meet the eligibility requirements outlined on the Retiree Scholarship Selection Criteria sheet.

Important:  All receipts must be submitted for reimbursement.  Rooms reservations will be made for scholarship awardees.

 


 

 

 

 

 

 

Please complete the following information:

Name

 

Phone Number

 

Address

 

City

 

State

 

Zip

 

Years of Service

 

Retirement Date

 

Employer

 

 

 

 

 

 

 

 

 

 

Have you held office or served on any committee of the WVPHA?   Yes       No 

If yes, what position and when?

     

 

 

 

Were you a paid member of WVPHA for at least 5 years before retirement?  Yes       No     

 

 

Have you received a conference scholarship in the past?  Yes      No  

If yes, when?

     

 

 

 

Are you under financial hardship?  Yes      No     

If yes, please explain.

     

       

      

 

 

 

 

 

Application Deadline:  August 1, 2008

 

Return Application to: Bill Kearns
800 Emmett Rousch Dr.
Martinsburg, WV 25401