Apply for a CDPAANYS Consumer Lobby Day Scholarship!

Please complete the following questions to apply for a Lobby Day Scholarship. All questions must be answered. For those that do not apply to you, write "N/A."

Your Full Name:

Telephone Number:


Fiscal Intermediary:

Do you work for a Fiscal Intermediary?

Are you a Consumer or Designated Representative?
ConsumerDesignated Representative

How long have you been using CDPA?

Where will you be traveling from?

What is your anticipated mode of transportation?

If you will be traveling by bus or train, what is the anticipated travel cost to Albany?
(This is not binding and will not affect your application; it is for planning purposes only)

What issues affecting CDPA are of greatest importance to you and why?

Please describe your history with advocacy and activism related to CDPA:

What previous involvement do you have, if any, with CDPAANYS?

Please list and describe any CDPA-related advocacy events and/or activities you have attended and/or participated in:

Please list and describe any additional activities you believe are relevant to this scholarship application (community groups, committees, boards, etc):

How will you continue your advocacy after Lobby Day?