International Convocation of Unitarian Universalist Women

Scholarship Application
Last Name:
First Name:
Middle Initial:
Title:
Address1:
Address2:
City:
USA State:
NonUSA County or State:
Country:
Postal Code:
Home Phone:
Cell Phone:
Fax:
Skype Name:
Email:
The Convocation policy is that scholarships be supplemented with other funds raised ("match funds" below). This includes any funds raised by your U.S. partner church to assist you. Please list below the funds you or your partners will pay for you (in US dollars). Please be specific.
Match Funds for Air (numbers only--no $ signs or commas):
Match Funds for Registration (numbers only--no $ signs or commas, ","):
Match Funds for Meals (numbers only--no $ signs or commas, ","):
Match Funds for Visa (numbers only--no $ signs or commas, ","):
Total Estimated Visa Costs (numbers only--no $ signs or commas, ","):
Total Estimated Air Cost (numbers only--no $ signs or commas, ","):
How should we contact you? Please select one option below
Email Option:
Phone Option:
Skype Option:
Postal Option:
Why are you interested in coming to the Convocation (maximum 500 characters allowed):
What is your major area of interest with issues that concern women in your country? (maximum 500 characters allowed)
Please tell us your age category by checking one of the ranges below:
Age18 or younger:
Age 18 to30:
Age 30 to 50:
Age 50 or more:
Will you need a letter of invitation? :
If you will be travelling with a friend, please give their name :
Your Congregation Name:
Please give your religious affiliation by check one of the boxes below:
Unitarian Universalist:
Universalist:
Unitarian:
Other:
Specify Other: