Dartmouth Local

Surveys and Quizzes

Local Conference Grant Application

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Your full name:


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Your six digit professional number:


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Your school/work site:


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Your contract status (Permanent, probationary, term):


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Your mailing address (including postal code):

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Your home phone number:


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Alternate phone number (work or cell):


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Your email address (non-HRSB preferred):


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Name of conference:


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Location of conference:


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Start date of conference:


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End date of conference:


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Brief description of conference:

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Conference website:


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Conference registration fee:


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Estimated travel cost:


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Estimated cost for accomodations:


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Estimated cost for meals:


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Have you applied for Article 60 funding? (Yes/No):


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Have you been approved for Article 60 funding? (Yes/No/Pending):


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Have you applied for or been approved for other sources of funding? (Yes/No):


If yes above, what type(s) of funding:

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Have you read and do you understand the guidelines for Dartmouth Local PD funding? (Yes/No):