NANCY TATEM EDUCATION SCHOLARSHIP FUND APPLICATION FOR REIMBURSEMENT Name: Date: Center/Facility: Address: Phone: Fax: E-Mail: Web Site: www.     Parent Organization or Facility: Length of current employment at above Center/Facility:     Course/Conference: Date of Course/Conference: Amountt Requested: Reimbursement to: Center Applicant Other (list below) List Other: Member of PADSA: Yes No If yes, length of membership: BRIEFLY OUTLINE HOW THIS COURSE/CONFERENCE WILL OR HAS INCREASED YOUR KNOWLEDGE AND ABILITY TO SERVE THE PARTICIPANTS OF YOUR CENTER: Send the following: Copy of couree/conference brochure or description Receipt of payment for course or conference Send to: PADSA BOARD NANCY TATEM EDUCATION SCHOLARSHIP FUND COMMITTEE 525 South 29th Street, Harrisburg, PA 17104 Toll free: 1.866.398.7797 www.padsa.org/E-Mail padsa@padsa.org If you would like a hard copy of the form to fill out, please click here. In order to view/print the Application, you must have Adobe Acrobat Reader installed on your computer. Adobe® Acrobat® Reader®is free software that allows you to view and print Adobe Portable Document Format (PDF) files. To download Acrobat Reader simply click the icon above and follow the instructions for installation. Upon completion, return to this page and click here.
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