Arlene Long Memorial Fund Application

Applicant Contact Information

*First name

*Last name

Multi-line address

*Country/Region

*Address

*City

*Zip / Postal code

*Email

*Phone

*Type of phone

Voice

Videophone

Other

Background Information

*Category of funding

Interpeter

Sign Language Teacher

Additional Training

Other

*Total years of experience

*Number of Years as an Interpreter/Sign Language Teacher

*Please describe your goal and how this additional training will help you achieve it

*If you receive this funding, how do you plan to give back to DHCC and the Deaf community?

Information about Training Requested

*Title

*Cost

*Location

*Instructor

*Dates of class/workshop

Flyer/details of class

I have read and understood the Terms and Conditions of the Arlene Long Memorial Fund/Scholarship.

If selected as the recipient, I will abide by these rules.

*Signature

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DHCC accomplishes our mission through communication access services, education, and advocacy. We advocate for Deaf and Hard of Hearing individuals to help them gain communication access to services, businesses, educational institutions and their own places of employment.

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