Click for printable Scholarship Application Form

A limited number of scholarships are available from the Florida School of Addictions Studies. Each scholarship covers the full cost of tuition plus meals and other activities that are part of the FSAS. Scholarships DO NOT INCLUDE THE COST OF DORM OR HOTEL ACCOMMODATIONS. Criteria for awarding the scholarships are: demonstrated financial need, interest, activity in the addictions field and willingness to share knowledge and experience gained with others. Applicants must agree to share their observations and impressions regarding the FSAS experience with the Scholarship Committee IN WRITING, at the end of the school and meet the criteria specified by the various agencies that donate scholarship funds (see details on reverse side).

To apply, please complete this form and return it to the FSAS Registrar by May 2, 2008. All applicants will be notified of the Scholarship Committee’s decision by Friday, June 13, 2008.
ALL INFORMATION SUBMITTED MUST BE LEGIBLE

Name: _____________________________________________ Degrees/Certificates:______________________________
(first) (middle) (last)
Address:___________________________________________________________________________________________
(street) (apt. #) (city) (state) (zip)

Home Phone: (___)_________________________ Home E-Mail:______________________________________________
Employer and/or School:________________________________ Program Name:__________________________________

Work Phone:(____)__________________________Work E-mail:_______________________________________________

Address:____________________________________________ City:_______________________ State:_____ Zip:_______

Supervisor’s Name:_______________________________________

I would like to attend the 27th Annual Florida School of Addictions Studies because: _________________________________

___________________________________________________________________________________________________

How many years have you attended the FSAS? #_____ How many times have you attended FSAS on scholarship? #______

My career goals in the field of addictions are: _______________________________________________________________

___________________________________________________________________________________________________

I need financial assistance to attend the Florida School of Addictions Studies because: ______________________________

___________________________________________________________________________________________________
Do you plan to attend a full 20-hour track or one or two 10-hour mini tracks?: 20-hour track:_____; 1 mini:____; 2 mini’s____

Applicant’s Signature:_________________________________________ Date:___________________________________

Attached is________Letter(s) of Recommendation from: _____________________________________________________
(number) (list individual(s) supporting application for scholarship)

Acceptance of this scholarship binds the applicant to share his/her observations and impressions regarding the FSAS experience with the Scholarship Committee, in writing by July 24, 2008 (the close of the school). For consideration, please return this completed form and letter(s) of recommendation by Tuesday, May 2, 2008 to:

FSAS Scholarship Chair
1725 Art Museum Drive
Jacksonville, FL 32207

Telephone: 1-888-933-FSAS E-mail: fsas@nefsc.org Web Site: www.fsas.org