ASPCA / NACA Training Scholarship Application Form Download NACA's Scholarship Policy Applicant Information Last Name* First Name* Are you a current NACA Individual Member? YesNo Does your agency have a current NACA Agency Membership? YesNo I have reviewed the scholarship application policy and am eligible to apply:Enter Your Individual or Agency Membership Number*: Organization or Agency Name*: Position, Title or Rank*: Organization Mailing Address(1)* Organization Mailing Address (2) City* State* Zip* Preferred Telephone Number*: Alternate Phone: Your email* Date of Birth*: M/D/Y Gender*: Race*: Course/Training Seeking Scholarship For*: —Please choose an option—ACO IACO IIDispatch Essentials Organization Statistics/Information Population of Jurisdiction (City or County) Number of Team Members: Full Time Part Time Contract Volunteers Annual Intake: Dogs Cats Others Annual Calls for Service: Cruelty Total Dangerous Dog Nuisance Annual Organization Budget: Annual Training Budget: Current Programs (Check all that apply): Adoption ProgramFoster ProgramBehavior/EnrichmentCruelty InvestigationDangerous Dog InvestigationCommunity Outreach/EducationPublic Spay/Neuter Please explain how scholarship funding will support your agency and its training program. Are you seeking and would be ok with: FULL ScholarshipPARTIAL Scholarship Would you be unable to attend without a full scholarship? YesNo Would you be unable to attend without a partial scholarship? YesNo If yes, what’s the minimum amount? Applicant Areas of Expertise Years of Service* Other Trainings Attended* In 250 - 500 words please tell us how this training will benefit you, your organization, and the animals in your community?* NACA represents Animal Control and Animal Welfare professionals from all across the country. This includes individuals from a wide variety of organizations with varied clientele, demographics, resources, services provided, etc. We understand these diverse challenges and want all potential applicants to know, individual answers will be weighted based on creativity and passion and not on performance of any individual's organization. Please fill out the essay to the best of your ability (in the language in which you feel most comfortable) and with information you feel comfortable sharing with NACA STATEMENT OF ACCURACY FOR STUDENTS I hereby affirm that all the above stated information provided by me is true and correct to the best of my knowledge. By signing below my supervisor and I acknowledge the time commitment of the course applied for and commit to attending barring any unforeseen emergencies. Scholarship Applicant Name*: I Affirm Date Submitted: Supervisor/Director Name*: I Affirm Date Submitted: Email Address of Supervisor/Director*: How did you hear about the scholarships?* Please Select:NACA WebsiteOther WebsiteNACA Social MediaOther Social MediaNACA Newsletter/EmailMagazine or other publication Submit By submitting this application you are agreeing that you have read the NACA Scholarship Policy.
