Lobby Days 2017 Scholarship Application

Thank you for your interest in attending the NCMMH's 2nd Annual Advocacy Days in Washington D.C. this year. Please fill out the below information to be considered for one of the 20 scholarships being provided to cover hotel (1-2 nights) and registration cost. Recipients will be responsible for their own travel costs. Apply by Tuesday 4/18. Applicants will be informed of decisions by Friday 4/21, so there is ample time for recipients to make travel arrangements.

Name

First Name

Last Name

Email Address

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Please tell us why you would like to attend lobby day and how a scholarship would help:

Please tell us how you would like to use the experience of advocating in DC to help with activities in your state:

National Coalition for Maternal Mental Health

What does a maternal mental health disorder feel like? Watch the NCMMH's PSA.