Please fill out the form below to submit your application.


    Name of Organization (required):

    Primary Contact Full Name (required):

    Primary Contact Email (required):

    Primary Contact Phone Number:

    Primary Contact Business Street Address 1:

    Primary Contact Business Street Address 2:

    Primary Contact Business City:

    Primary Contact Business State:

    Primary Contact Business ZIP Code:

    What year are you intending to apply for?

    What is your vision for this Summit?

    What steps do you propose to take to build upon the innovation of previous Summit events?

    Who are you partnering with in this endeavor? (Often a State Vocational Rehabilitation agency or several agencies will partner with a TACE Center or university to expand the support that is useful in completing conference preparations).

    What logistical support do you have available to use in the planning and implementation of this event?

    What is the intended location for this event? It may be helpful to identify several venues where it might be held. The venue should have space to accommodate a group of 180 or more attendees.

    Thank you for taking the time to fill out this application.

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