Drug and Alcohol Testing Industry Association
1325 G Street, NW, Suite 500#5001
Washington, DC 20005
800.355.1257 (p)
202.315.3579 (f)

The Diana Bauske Educational Scholarship Application

All applications should be e-mailed to lshelton@datia.org. Applications must be received at least 8 weeks prior to the program date for which you are applying. No late entries will be accepted. Donations are not deductible as tax-exempt.

SECTION I - Personal Information


Your Name

Company Name






(Only nubmers are allowed.)



Role/Major Position Responsibilities:

SECTION II - Program Selection (Please select one)

Course/Program Date

DATIA Annual Conference

Advanced DER Course

Auditing Success Course

Certified Professional Collector Trainer Course

Consortia/Third Party Administrator Best Practices Course

Designated Employer Representative Train the Trainer Course

Developing an Effective Supervisor Training Program Course

Ins and Outs of Drug & Alcohol Testing Course

Medical Review Officer Assistant Training Course

I am also seeking travel reimbursement of up to $250

To find dates for upcoming courses visit: http://datia.org/educations/datia-courses.html

SECTION III - Your Goals

How do you plan to give back to the drug and alcohol testing community?

What are your professional goals (long or short term)?

What do you hope to gain from your participation in your selected education program?

Why do you feel you need/deserve consideration for these funds?

Other Information you feel important for us to know:

I attest to the veracity of the information in this application.