AFP Florida Suncoast Chapter

Scholarship Application Form

*First Name:

*Last Name:

*Organization:

*Title:

*Address:

*City:

*State:

*Zip Code:

*Phone Number:

*Fax Number:

*Email Address:

*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: Available characters remaining:
i.e., Registration, Housing, Travel, Food, etc.

*Have you ever received an AFP Scholarship?: YesNo

*If yes, please state when, amount received, and program funded.: Available characters remaining:

*On what AFP committee do you serve?:

*By whom is this committee chaired?:

*Have you made a gift to the Every Member Campaign this year?: YesNo

*Please state briefly what need or educational objective will be achieved through this scholarship.: Available characters remaining:

*How will you determine the success of your goals/objectives?: Available characters remaining:

*Will additional funds, if necessary, be paid by you or by your organization?: I will pay any necessary additional funds.My organization will pay any necessary additional funds.

*Does your organization support your educational/professional goals?: YesNo

*If so, in what way?: Available characters remaining:
Ex: Budget for Seminars/Meetings

Note: Scholarship recipients must agree to give a brief evaluation or testimonial of the benefits received from conference attended or course taken.

*By checking this box, I give the electronic equivalent of my signature.:

*Date:

*Spam validation:

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AFP Florida Suncoast Chapter

Membership