Adult Scholarship Application

Information

The application for CADCA’s 37^th Annual National Leadership Forum Scholarship program is now open!
Deadline: Oct. 1

First Name
Last Name
Email
Company Name

First Name [REQUIRED]

Last Name [REQUIRED]

Applicant Job Title [REQUIRED]

Coalition or Organization Name

Address [REQUIRED]

Email Address [REQUIRED]

Are you located outside the U.S.? [REQUIRED]

clear selection

Yes

If you are from outside the U.S, please enter the country

Applicant's Gender [REQUIRED]

Applicant's Ethnicity [REQUIRED]

clear selection

American Indian or Alaskan Indian

Asian or Pacific Islande

Black or African American

Hispanic or Latino

White (non Hispanic)

Other (Please specify)

Are you or your organization a current CADCA member? [REQUIRED]

clear selection

Yes

Have you attended CADCA's Leadership Forum in previous years? [REQUIRED]

clear selection

Yes

Have you received a scholarship to a previous Mid-Year or Forum? [REQUIRED]

Failure to respond truthfully to this question will result in automatic disqualification.

clear selection

Yes

What is your primary professional role? [REQUIRED]

clear selection

State Prevention Leader

State Treatment/Recovery Leader

Community Prevention Leader

Community Treatment/Recovery Leader

Coalition Member

Coalition Volunteer

Student

How many years have you actively been involved in the anti-substance abuse/prevention field? [REQUIRED]

What is your coalition's/organization's primary geographic target area? [REQUIRED]

Frontier

Urban

Rural

Suburban

Provide an example of how you showcased your skills to support a recent project that your state/community coalition has/is working on? [REQUIRED]

Tell us why you should receive a scholarship for the CADCA 2025 Forum [REQUIRED]