Arlene Long Memorial Fund Application

Applicants that meet eligibility requirements may proceed to fill out the application form below.

Applicant Contact Information
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Email Address*
Phone Number*
Type of Phone*
- Voice
- VideoPhone
Background Information
Category of Funding*
- Interpreter
- Sign Language Teacher
- Additional Training
Total Years Experience*
Number of Years as an Interpreter/Sign Language Teacher*
Please describe your goal and how this additional training will help you achieve it*
If you receive this funding, how do you plan to give back to DHCC and the Deaf community?*
Information about Training Requested
Title*
Cost*
Location*
Instructor*
Dates of Class/Workshop*
Agreement*
I have read and understood the Terms and Conditions of the Arlene Long Memorial Fund/Scholarship.
If selected as the recipient, I will abide by these rules.

DHCC accomplishes our mission through communication access services, education and advocacy. We advocate for Deaf and Hard of Hearing individuals to help them gain communication access to services, businesses, educational institutions and their own places of employment.

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Name(Required)

First Last

Email(Required)

Phone(Required)

Arlene Long Memorial Fund Application

Applicant Contact Information

Background Information

Information about Training Requested

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Join the DHCC Email List