Scholarship Application

Virginia Animal Control Association

Providing a united voice for Animal Care & Control Professionals throughout Virginia!

VACA 2022 Conference Scholarship Application Form
Application Deadline: September 1, 2022

Supervisor Phone *

Agency: *

Approval to Attend *

YES

Name: *

Affirmation of information *

The applicant affirms he/she has given true and accurate information to the best of his/her knowledge and gives permission for VACA to contact the listed names.

Supervisor Name *

Scholarships *

Conference Registration & 3 days lodging

Conference Registration

Conference Registration (Past President Scholarship)

Last training event/conference attended *

Address *

Phone *

Is your agency providing any funding? *

YES

Email: *

Affirmation of membership *

The applicant affirms he/she is a current active/associate member.

Title: *

Length of Service *

Explain in detail how you & your agency would benefit from your attendance at the VACA Conference: *