Tell us about....
First Name
Last Name
Email Address
Zip Code
What was one thing you think worked best about last year's application?
What was the one thing you think needs the most improvement in this year's application process?
How diverse did you think last year's winners were? What kinds of diversity would you value in this year's winners?
How/where did you first hear about the DFA/NN scholarship?
How/where else would you suggest we find applicants for this year's scholarships?
What was the hardest question to answer on last year's form?
What do feel was the best question we asked on last year's form?
What do you feel was the most pointless question on last year's form?
Last year we wanted to ask a question that forced people to be creative (the McCain bumper sticker Q). What should we ask this year?
Suggest one more question for us to ask this year:
Volunteering this year - Would like to help with the selection process?
Volunteering this year - Would like to help with outreach?
Volunteering this year - Would like to help with fundraising?
* marks required fields
Click image to see a screen shot of last years application
Videos of some of the 64 House Healthcare Heroes standing strong for a public health insurance option Congressman Emanuel Cleaver Congressman Lloyd Dogget Congressman Keith Ellison Congressman Bob Filner Congressman Phil Hare Congresswoman Lynn Woolsey Congresswoman Maxine Waters