Family Conference Scholarship Application

Please select your attendance type:

In-Person
Virtual

First Name *

Last Name *

Email *

Phone Number *

Mailing Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

What type of leukodystrophy is your family affected by? *

What year were you or your affected family member(s) officially diagnosed? *

Have you received a scholarship or financial assistance from the ULF previously? If yes, which year(s)? *

Statement of Financial Need: *

Please describe your current financial status. Scholarships are awarded to families who are in financial need to be able to attend the Family Conference.

Scholarship Guidelines Agreement *

I have read and agree to the scholarship guidelines.

Contact the ULF

Google Translate

Double Your Donation