NARCH Training

Travel Scholarship Form

Application deadline is May 9th.

First Come First Served—priority will be given to American Indian/Alaska Native Graduate Students. See additional notes below the form.

Fields marked with * are required.

Contact Information

First Name: *

Last Name: *

Student: Yes No

Student At:

Street Address: *

City: *

State: *

Zip Code: *

Tribe/Organization:

Telephone: *

Fax:

E-mail: *

I am requesting a travel scholarship to attend:

Class #1

Class:

Date:

Class #2

Class:

Date:

Class #3

Class:

Date:

Training Locations: Northwest Portland Area Indian Health Board, 527 SW Hall, Suite 300, Portland, OR 97201 and/or Oregon Health & Science University, Portland, Oregon.

I understand NW NARCH can assist with federally allowable expenses (travel, hotel, per diem, mileage, ground transportation) not to exceed $1,000. By requesting travel assistance, I hereby agree to the following:

If I am going to utilize the funds for commercial travel (air, train, bus), I will call or e-mail Luella Azule at (503) 228-4185 x 275 or e-mail summerinstitute@npaihb.org for a purchase order number. After I obtain a purchase order and project code, I will call Travel by Terri at (503) 481-3590 or e-mail terri@travelbyterri.com to make my commercial travel arrangements.
I will use my personal credit card, if required, when making my lodging reservations and will ask for the federal government rate.
I will submit all my original receipts for everything but mileage and meals, along with a travel report, within ten working days after the event.

By submitting this Travel Scholarship Agreement, depending on fund availability, I understand the NW NARCH may provide me with a full or partial travel scholarship. I also understand that I will be reimbursed only for the Federally Allowable expenses contingent upon providing the NW NARCH with the required travel report and receipts.

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