LIVED EXPERIENCE WAIVER — PARTNERS IN CARE

Each individual with Lived Experience will need to complete their own “Lived Experience Scholarship Application Form” to be considered. Scholarships will be available on a first come, first served basis.

NAME *

First Name

Last Name

PHONE *

(###)

###

####

EMAIL *

IMPORTANT NOTE: Each individual completing this form will need to use their own, unique email address. Please DO NOT use another person's email, only use your own.

WHAT ISLAND WILL YOU BE TRAVELING TO THE CONFERENCE FROM? *

Island Of Hawai'i (BIG ISLAND)

Maui

Moloka'i

O'ahu (no travel)

Kauai

WHICH DAY(S) OF THE CONFERENCE DO YOU PLAN TO ATTEND? *

DAY 1 (Thursday, November 13)

DAY 2 (Friday, November 14)

BOTH DAYS

I CONFIRM THAT I HAVE LIVED EXPERIENCE.

YES

LIVED EXPERIENCE SUMMARY *

Please share a brief description of your lived experience with homelessness.

LIVED EXPERIENCE CONFERENCE GOALS *

Please share something you hope to learn or gain by attending the 2025 Hawai'i Homelessness & Housing Conference.

Are you open to talking about and/ or sharing about your Lived Experience with homelessness? *

Yes

Thank you!

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PARTNERS IN CARE - 200 N VINEYARD BOULEVARD, SUITE A-210, HONOLULU, HI 96817

EIN # 84-1705573