CARES Scholarship Interest Form

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CARES Scholarship Interest Form

Hello,

Thank you for expressing interest in the CARES scholarship opportunity from Dementia Friendly Nevada!

Upon completing this interest form, a representative from Dementia Friendly Nevada will contact you within 3 business days to finalize the registration process!

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* Indicates required question

First Name *

Your answer

Last Name *

Your answer

Email *

Your answer

Phone Number *

Your answer

Are you a Nevada resident or do you provide support to a resident of Nevada? *

Yes

No

Do you have a device with internet access? *

Yes

No

Preferred CARES Course *

Dementia Basics in English

Dementia Basics in Spanish

Dementia Care for Families

Any Questions?

Your answer

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