2021 Conference Scholarship Application

Name of Applicant (required)

Name of Organization (if applicable):

Address (required)

County (required)

Phone (required)

Your Email (required)

Website

List any permits you possess: (if applicable):

List any permits you will be applying for: (if applicable):

Are you a 501(c)(3)?:
---YesNoAwaiting Approval

If you are not permitted, please list any wildlife rehabilitator/center where you have volunteered:

Contact person at that facility:

Contact person's phone:

Contact person's email:

Have you previously applied for a scholarship from the Pennsylvania Wildlife Rehabilitation and Education Council?
---YesNo

Please give a brief explanation as to why you need assistance in attending the conference: