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Association of Fundraising Professionals
Indiana Chapter
Scholarship Application
This application form is to be used by applicants* requesting scholarship from the Indiana Chapter of the Association of Fundraising Professionals. It must be submitted to the Professional Advancement Committee. A letter of support and references must accompany this application from theorganization’s Chief Executive Officer or Board President. Please review Scholarship Guidelines for details.
*Membership in good standing in AFP is required of applicants.
AFP Member #___________
Conference or Course Description: ______________________________________________________________
______________________________________________________________________________________________
I. Personal Information
________________________________________________ _______________________________________
Name Title
________________________________________________ ______________________________________
Organization Name Chief Executive Officer
_____________________________________________________________________________________________
Organization Address City State Zip Code
Home Address City State Zip Code
__________________________________________ _________________________________________
Organization Phone Home Phone
# of Yrs at Organization # of Yrs in Profession AFP Member? # of Yrs AFP
Other Fundraising professional experience? ____Yes ____No
If Yes, please specify number of years and organization name(s):
II. Rationale for Attendance
Please explain, in the space provided or on a separate document, why you would like to attend the conference or course and the benefits of your participation.
The intent of this scholarship program is to make available continuing educational opportunities, which would not otherwise be available to the participant. Please answer thefollowing questions:
Would you be able to attend the program without this scholarship? ____Yes ____No
Does your organization budget for conferences/seminars? ____Yes ____No
If yes, explain why the budget will not allow you to attend this particular program:________________________________________________________
Do you work for a 501(c)(3) organization? ____Yes ____No
Please state thetotal budget of your 501 (c)(3) organization $___________
Do you work for a for-profit consulting firm? ____Yes ____No
Have you previously received an IC/AFP scholarship? ____Yes ____ No
If yes, please indicate when_____________________________________
I agree to complete and return the post-conference Evaluation Form and Final Accounting Form. Also, I agree to submit a copy of a receipt of registration for the conference. Failure to complete the Form will forfeit your right to future scholarships.
Applicant’s Signature Date
Return the form to: Katherine M. Finley, CFRE, CAE, Scholarship Committee Chair, c/o REISA, Two Meridian Plaza, 10401 N. Meridian Street, Ste. 202, Indianapolis, IN 46290 or fax it to 317-815-0871 or email it to kmfinley@reisa.org
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