2023 ICAN Women's Leadership Conference Scholarship Application

May 17, 2023

Applications must be received by April 12, 2023.

Selections will be announced by May 1, 2023.
You will be notified either way.

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Learn more about the 2023 conference agenda, speakers and more at ICANconference.com

First Name

Last Name

Company/Organization

Title:

E-Mail

Cell Phone

Daytime Phone

Business Address (If Applicable) :

City:

State:

Zip Code:

Home Address:

City:

State:

Zip Code:

What makes you uniquely suited to receive a scholarship for the 2023 ICAN Women's Leadership Conference

What do you hope to gain by coming to the conference?

After the conference, what will you do to pay it forward with others?

What is your current role and position?

Is your employer willing to give you the time off in order to participate in the conference on May 17 or will you have to take a holiday?
(If applicable)

What is your Race / Cultural Background?

AsianBlack or African AmericanHispanic or LatinoIndianMiddle EasternNative Hawaiian or Other Pacific IslanderWhite/CaucasianTwo or More RacesI prefer not to DiscloseOther

If selected 'Other' above - please indicate the term you would like us to use:

What is the size of your household?

Is your combined household income level $52,000 or less?

YesNo

Please select if you would like to attend the conference virtually or in-person at the CHI Health Center.

Virtual AttendanceIn-Person Attendance

Please Note: Should you be selected, by registering for and participating in the ICAN Women's Leadership Conference you grant permission to ICAN, Bank of the West or Lozier Foundation for use of any pictures or video taken at the event, that may include you, to be used in any form for future materials, promotions and publications.

Contact Information