Texas Clogging Council Stipend Application
Completed application and reimbursement receipts should be sent to the address or email address below. All submission materials must be received by February 8, 2023.

Kayla Barton, Education Director
2703 Taylorcrest
Missouri City, TX  77459
(812) 568-5069
or
tcckaylab@yahoo.com (preferred)
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IMPORTANT:  Applicants must read and acknowledge the following Texas Clogging Council Education Stipend Requirements *
Required
GENERAL INFORMATION
Applicant Name (Last, First, Middle Initial): *
Permanent Address: *
Telephone Number: *
Email Address: *
How long have you been a member of the Texas Clogging Council? *
What activities (academic, clogging, community service, etc.) are you currently involved in or have been involved with relating to the goals and objectives of the Texas Clogging Council? *
Please describe the activity/course/certification program/etc. for which you are seeking a stipend. Please be thorough in your response and include information on your goals as it pertains to the continuing education for which you are seeking the stipend.  *
Total amount of stipend requested: *
Please send registration receipts reflecting this amount to tcckaylab@yahoo.com
My electronic signature below certifies the information provided in this application is accurate and complete to the best of my knowledge. *
Date: *
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