IACP Forum Scholarship Application

Please log in to your IACP profile before submitting the form.
Scholarship applications are due by July 14, 2023 at 5 pm PDT.
If you are applying for a Forum Scholarship, please DO NOT register for Forum until Scholarship recipients have been selected.
Scholarship recipients will be notified by July 28, 2023.

You will receive a confirmation email upon successfully submitting the Forum Scholarship Application Form, if you do not receive an email confirmation, please contact info@collaborativepractice.com

Contact 1

First Name

Last Name

Street Address

Street Address Line 2

City

Postal Code

Country

State/Province

District/County

Phone Number

Are you an IACP member? (Membership will be verified) *

How did you first learn about the scholarship program? *

If "Other" please provide details

Please indicate your primary professional designation: *

Attorney

Mental Health Professional

Financial Professional

Other (please specify)

If "Other" please provide details

Have you attended a previous IACP Forum? *

Please list the years you have attended:

Have you received a Forum Scholarship in the past? *

Please indicate the years you have received a scholarship:

FINANCIAL NEED: What is your current gross earned income (US Dollars)? *

Will you receive any funding support from your employer, practice group, or other source outside IACP? *

How many people in your household are financially dependent on you? (Not including yourself) *

What is your total household gross income (in US Dollars)? *

What is your current employment status? (Please select one) *

How would your attendance at this Forum benefit your local Collaborative community? What steps will you take to share your Forum experience with your local community? *

How would your attendance at this Forum contribute to expanding diversity in the Collaborative community? *

Are there any additional circumstances the IACP Scholarship Committee should consider? *

Please provide one professional reference from your community. Please be sure the reference knows you are providing his or her name and that they might be contacted. *