Scholarship Application
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First Name *
Last Name *
Organization *
Does your organization meet the AFP approved small organization criteria?
Address *
City *
State *
Zip Code *
Phone Number *
Email Address *
What scholarship are you applying for? *
Required
How long have you been a member of AFP? *
Conference/Course Title *
Conference/Course Date *
Total Estimated Expenses *
Scholarship Amount Requested *
To whom should the check be made payable? *
Cost to be covered by amount requested *
ie: Registration, Housing, Travel, Food, etc.
Have you ever received an AFP Scholarship? *
Required
If yes, please state when, amount received and funded.
On what AFP Committee do you serve? *
Have you made a gift to the Be the CAUSE Campaign this year *
Required
Please state briefly what need or educational objective will be achieved through this scholarship. *
How will you determine the success of your goals/objectives? *
Will additional funds, if necessary, be paid by your or by your organization? *
Required
Does your organization support your educational/professional goals? *
Required
If so, in what way?
Date *
MM
/
DD
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YYYY
Time
:
Signature *
By checking this box, I give the electronic equivalent of my signature
Required
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