Rural CHW Conference Waived Fee Application – Minnesota Community Health Worker Alliance

CHW Conference Waived Registration Fee Application

First Name

Last Name

Address

City

State

Zip Code

What are you barriers to attending the conference? (check all that apply)

I am not employed

My employer does not have professional development funds

My employer will not use funds to pay for my registration and/or transportation and/or hotel

Cost of transportation

Cost of hotel

Cost of registration

I would have to take PTO or vacation time to attend and/or my employer will not allow me to attend on paid time

I do not have any barriers at this time

Who is your employer?

Please submit your supervisor's name and contact information

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