AGWG Community Organizing Summit - Scholarship Application
Please fill out the form below if you are applying for a scholarship to attend the Appalachian Gas Working Group's Community Organizing Summit on April 6, in Weston, WV. Scholarships include registration, meals and lodging.

For more information, contact the AGWG Coordinator, Eve Marcum-Atkinson, at or 614-357-8533.

Email address *
First Name *
Your answer
Last Name *
Your answer
Phone Number *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Are you attending on behalf of a group or organization? Please list the organization below and provide a link to their website. *
Your answer
Please choose which nights you will need lodging. *
If requesting lodging, please select the type of dorm that best reflects your gender self-identification. *
Do you have any dietary restrictions?
Please provide a brief summary of why you are requesting a scholarship for the Community Organizing Summit. *
Your answer
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service