Pennsylvania Council of the Blind Application for Returning Convention Student Stipend


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Date:
Full Name: *
Mailing Address: *
E-mail Address: *
Home Phone: *
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Mobile Phone:
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Please answer the following questions:

1. How many times have you attended the PCB convention? *
2. Have you become involved in organizing the student affiliate? *
3. Have you joined PCB as a member at large or at a local chapter affiliate? *
4. In 100 words or less, please tell us why you would like the support of the $100.00 stipend. *