Required Criteria:
I wish to apply for an ICON Scholarship to attend a continuing education program: (two rounds offered per year, up to $250 each)
*Deadline First Round: April 1 *Deadline Second Round: August 1
* denotes a required field
Name of CE *
Sponsoring Agency of CE (conference, etc.) *
Cost of CE *
I am member in good standing with ICON. *
Name: *
Address: *
Address 2:
City: *
State: *
Zip: *
Work Phone: *
Home Phone: *
Email: *
Benefits I expect to gain from attendance include: *
I will report on my experiences by: Mini-training session Oral report at an ICON Meeting An article in the ICONnection