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CMHS Consumer Affairs E-News December 21, 2004  Vol. 04-116
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NMHA 2005 ANNUAL CONFERENCE JUNE

The National Mental Health Association (NMHA) 2005 Annual Conference
Hyatt Regency Washington on Capitol Hill, Washington, DC
June 9 - 11, 2005

Conference information available at:  1-800-969-6642 or www.nmha.org  

Application for Financial Support
Application deadline:  March 18, 2005

The Center for Mental Health Services (CMHS) within the Substance Abuse
and Mental Health Services Administration (SAMHSA), through a contract
with Westat/Health Systems Research, Inc. (HSR), is providing financial
support to consumers of mental health service who wish to participate 
in the annual conference sponsored by the National Mental Health 
Association.

The purpose of the scholarships is to foster transformation of mental
health care to focus on recovery.  Please note:  the completed 
application and letter of recommendation must be received by March 18, 2005 in 
order to be eligible for this scholarship.

Contact Information:

NAME:  ______________________________________________

ORGANIZATION:  ________________________________________________

ADDRESS:  ______________________________________________________

CITY:  ______________________  STATE: __________  ZIP: ___________

PHONE:  _____________________  FAX:  __________________________

E-MAIL:  ___________________________________________


Demographic Information:
Please provide the following optional information to help insure 
diversity of scholarship recipients.

Gender:  Male    Female       Age:  18-25  26-55   56+

Ethnicity:  Asian/Pacific Islander    American Indian   Black   Hispanic

               White    Other

Sexual Orientation:  Heterosexual   Gay   Lesbian    Bisexual

Physical Disability:   Yes   No

Are you a U.S. citizen?   Yes   No

Financial Support:
What type of scholarship support are you seeking?

Registration fee     Hotel expense    Per Diem    Ground transportation

Hotel expense       Travel costs:  airfare    train   mileage for car


Have you attended this conference in the past?
Yes   No     If yes, what year(s)?_________________________________

Have you ever received a scholarship to attend the NMHA conference in the
past?
Yes   No     If yes, what year(s)?_________________________________

Additional Information:
On a separate piece of paper, please provide the review committee with the
following information:

1.  What are the reasons you wish to attend the conference?
2.  How you will disseminate information obtained at this conference to
local or statewide consumer groups?
3.  What are the specific issues relating to mental health in which you
are most interested?
4.  Are you currently involved with any related programs and activities?
If yes, please describe.

Please provide at least one letter of recommendation with your completed
application.

Scholarship Conditions:
Please note that in order to be eligible for this scholarship you must 
be a U.S. citizen and a mental health consumer.  If you are selected as a
scholarship recipient, a representative of HSR will contact you by 
April 22, 2005 to discuss travel arrangements.  As a scholarship recipient, 
you will be asked to do the following:
1.  Submit a 2 to 5 page report to HSR within 2 weeks of the conclusion of 
the conference in a format provided by HSR.
2.  Submit an evaluation form to HSR within 2 weeks of the conclusion 
conference in a format provided by HSR.
3.  Submit a travel reimbursement form to HSR within 2 weeks of the conclusion 
of the conference.
4.  Inform HSR if you are unable to attend the conference or will be delayed 
in meeting the other three conditions.

Your signature below indicates that you have read and agree with the terms
above.

___________________________________________________________
Signature                                                             
Date

Completed applications and letter(s) of recommendation must be received by
March 18, 2005.
Please submit to:  	   Stephanie Hauser
                           Health Systems Research, Inc.
                           1200 18th Street, NW, Suite 700
                           Washington, DC 20036
                           Phone:  (202) 828-5100
                           Fax:  (202)  728-9469
                           E-mail:  shauser@hsrnet.com
                           Pager:  (800) 619-4175




The Center for Mental Health Services is a component of the Substance Abuse and 
Mental Health Services Administration, United States
Department of Health and Human Services.