Childcare, Dependent-Care and Disability Support Program Application

    Applicant Name

    Applicant Email Address

    Funds may be applied to only ONE of the following scenarios (choose one):

    A. Travel of a relative or other care provider to my home to care for my child or dependent while I present my abstract and attend the RNA Society Annual Meeting.
    B. Travel of my child or dependent to the location of a care provider who does not live in my community.
    C. Travel of a care provider to the RNA Society Meeting to care for my child or dependent at the meeting location. Funds may NOT be used for expenses to transport child or dependent to the meeting.
    D. Alternative support for care.
    E. Assistance for Disability during meeting.
    Indicate where the child or dependent care provider is traveling to and from:
    Indicate where the child or dependent is traveling to and from:
    Indicate where the CARE PROVIDER will be traveling from:
    My child will be of the following age as of the meeting start date:
    My anticipated dates of attendance at the RNA Society Annual Meeting are:
    Abstract Identification Number:

    Name supporting document files according to this format:

    Lastname_Benefitstatement.pdf
    Lastname_Abstract.pdf
    Lastname_CV.pdf

    Benefit Statement (indicate how meeting attendance will benefit your professional development)
    Abstract — copy of abstract submitted as first/presenting author.
    Resume or abbreviated curriculum vitae (approximately two–three pages)