Please answer the questions below. We cannot award scholarships to anyone who does not fully complete this application. Answers must be provided by the applicant. All youth are required to complete this application themselves or with assistance if needed.

Youth Scholarship Information
Which of these best describe you? Please check all that apply.
Are you affiliated with a family support program, youth group, coalition, support group or advocacy organization?
 
*If yes, please state the name of the program and nature of affiliation (ex: volunteer, program participant, advocate, etc.)
Are you a youth representing a program, network, or other constituency as their representative?
 
If yes, please provide a brief statement from the program or network outlining why they would like you to represent them, and the name and phone number of the contact person. Also, please indicate if they can provide any financial support towards your expenses.
Why do you want to attend this conference? Please provide a brief paragraph detailing how you will specifically bring your conference experience back to your community to benefit other family members and/or youth.
I give permission to Families Together to photograph and/or videotape this registered child and to use his or her image in photographs, video, and/or film for the purpose of promoting the mission, activities, and pro-grams of Families Together. I understand that this registered child and his/her parent/guardian/legal authority is not entitled to any compensation or rights in these materials, and I release Families Together from any liability for the use of this registered child’s image for the above stated purpose. Please check.
Liability Statement: I have the legal authority to register this child for this event and I give permission for this child to attend the FTNYS Conference. I understand that this child must be supervised by the accompanying parent, caregiver or chaperone. This child agrees to abide by the rules of the conference. I understand that FTNYS and its staff are not responsible for monitoring this child and I will not hold Families Together in New York liable in the event of injury.
Youth/Child Registration Info

COMPLETE THIS SECTION FOR ALL CHILDREN AND YOUTH UNDER 21 REGRISTRATIONS
The accompanying guardian must be registered separately
NOTE: Children under 5 MUST remain with their parent.

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