ACT Midwest Chapter 2019 Scholarship Application
The ACT Midwest Chapter will award four scholarships of $500 each to assist with expenses associated with attending the four conferences hosted by ACT. Documented expenses reimbursed include: conference registration, travel and lodging.
Application Requirements:
1) Applicant must be a current member of the ACT Midwest Chapter in good standing.
2) Application must be filled out completely and submitted by the deadline listed below.
3) Applicant must attend and fully participate in the designated Conference.
4) Scholarship funds may only be used for eligible conference expenses: registration, travel, and lodging.
5) Actual expenses must be presented to the Treasurer with proper documents (ex. receipts) no later than 30 days after the designated Conference.
6) Recipients will be asked to write an article about their conference experience for the Chapter newsletter.
7) Recipients are strongly encouraged to participate on Midwest Chapter Board in the future.

Name of applicant *
Your answer
Position/title of applicant
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Company/organization *
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Address *
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Phone number *
Your answer
Email *
Your answer
Briefly describe your role in transportation demand management (TDM): *
Your answer
Briefly describe how attending the conference would benefit your personal development as a TDM professional, as well as further the goals of your company/organization and ACT Midwest Chapter: *
Your answer
List any positions, responsibilities, or services that you have held or performed for any ACT chapter / ACT organization: *
Your answer
Do you have a funding source(s) for conference attendance expenses not covered by the scholarship? *
Have you received a conference scholarship from ACT Midwest in the past? *
Which of the following events you are applying for? If applying for multiple events, please submit a separate form for each *
Required
By submitting this application for an ACT Midwest Chapter scholarship to up to $500 in expenses associated with your attendance, you certify that the information above is, to the best of your knowledge, correct and truthful. Scholarships will be awarded at the sole discretion of the ACT Midwest Chapter Board.
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