Brain Injury Association of Virginia Scholarship Request
RequiredRequired Question(s)
Scholarship Request
Deadline for Request: February 8, 2019
The Brain Injury Association of Virginia (BIAV) is able to assist a limited number of people with the cost of our 2019 Making Headway Conference. This assistance is available to caregivers and/or family members of individuals with a brain injury and individuals with a brain injury.  BIAV offers scholarships, based on need, date of request form receipt and availability of funds. 
Interested parties are required to submit this Scholarship Request Form. If you are applying for a registration fee scholarship for multiple family members please complete a separate scholarship request for each individual.  If you are applying for an overnight room scholarship please place the names of the individuals staying in the room in the "Name of Applicant" portion of the form with the responsible party listed first. Room scholarships are only available to those who must travel over 100 miles to attend the event.  
Questions - 

Required 1.

Name of Applicant


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Required 2.

E-mail address


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Required 3.

Phone #


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Required 4.



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Required 5.

I request assistance with the following:

Registration fee for the Making Headway Conference
Hotel/Lodging (if you live over 100 miles from the event location you may request hotel accommodations for March 8, 2019. (Lodging includes room only, not incidentals.)
Required 6.

Please explain your financial need for a scholarship for this event:


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Required 7.

Please share any other important information in consideration for this scholarship:


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Required 8.


I understand that any assistance provided by the Brain Injury Association of Virginia will be determined on an individual basis. In the event I am unable to attend the event, I will notify BIAV by March 1, 2019 so that my spot may be made available to another individual.
Please enter the responsible party's name below to signify you have read the above statement. Thank you.   


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