2023 NE and SE District Convention Grants Application

Applicant Name(Required)

First Last

Applicant Job Title(Required)

Applicant Email(Required)

Facility/Program Name(Required)

Select your IHCA District:(Required)

Southeast District

Northeast District

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Name of individual to attend the 2023 IHCA Convention (If not applicant)

First Last

Individual's Email(Required)

Would this individual attend the Convention if this grant were not available?(Required)

Please share a brief description of why this individual should attend the IHCA Convention.(Required)