in partnership with
CONFIDENTIAL APPLICATION
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Your information will be kept confidential except to screen and review the information for award
We release your name for post-award publicity only if award is given.
(5) Conference Scholarships will be awarded to Corporate Planners in the meetings industry.
Scholarship will include conference registration, hotel accommodations, airfare and daily per diem
stipend up to $2,800 per scholarship award.
Scholarship application deadline is May 25, 2013.
Scholarship award notifications will be made on June 8, 2013 via email.
Section I: About You
* First Name:
* Last Name:
* MPI Member #:
* Employer:
(enter N/A if not currently employed)
* Home Address:
* City:
* State/Province:
* Postal Code:
* Country:
* E-mail:
* Day Phone:
Alternative Phone:
URL:
(enter your web address if you have a personal web site)
(Only the information below this area will be submitted to the review committee.)
Section II: About Your History
* Membership Type:
* Gender:
* # Years In Meeting Industry:
# Years with MPI:
CURRENT Employment Information
If you are a business owner, indicate the number
* Employment Status: of employees in your firm:
* Current Employer:
(enter N/A if not currently employed)
Current Title:
Role / Major Responsibilities:
Position You Report To:
Number of positions this person is from
the top:
IMMEDIATE PAST Employment Information
If you were a business owner, indicate the
* Employment Status: number of employees in your firm:
Past Employer:
Past Title:
Role / Major Responsibilities:
Position You Reported To:
Number of positions this person was
from the top:
FINANCIAL & HOUSEHOLD Information
* Total Household Income:
*No. of Children:
* Child care?:
* Sole Provider?:
PRIOR EDUCATION
*# Years of college:
Completed Degrees: Major
Institution
Year
*In the space allowed, please describe or list; 1) Other formal or informal
education/certification or experience which is important for us to know. Provide year and
institution when appropriate, but do not include individual workshops or other related
short sessions. Examples to list would be an employer-related Executive Development
Program or an all-day or more leadership event; 2) Leadership experience in your life in
general. Items to include would be leadership you have or are involved with in community,
church or school. Or, if you have not had the opportunity to lead yet, how do you intend to
do so?
Section III: About Your Plans
In a few words, please tell us; 1) What your dreams are, what you hope
to accomplish and how you hope to get it; 2) How you plan to give back,
or lead your business community to demonstrate the value of the money
given to you by MPI; and 3) How you plan to contribute to the Meeting
and Events Industry.
*Your Goals:
*Amount Requested:
$
Please be specific. For example, full-(or part-time) tuition for one
semester in the amount of $XXXX. Or program fee in the amount of
$XXXXX.
*Scholarship will be
used for:
*Category(s) of
Funding:
If you selected COLLEGE RELATED above, answer the following questions:
Accepted in:
Offered by:
Date:
Name of course, program or class:
Name of institution or organization offering the course:
Enter the starting date of study/date of program:
Name & phone number (or e-mail) of person who can verify your
Verification
acceptance in course or program:
Information:
If you selected OTHER PROGRAM above, answer the following questions:
Name of leadership course, program or class:
Wish to attend:
Name of institution or organization offering the course:
Offered by:
Date:
Enter the starting date of study:
If this course leads toward certification, list certification and sponsoring
Certification? agency:
Online Course?:
Name & phone number (or e-mail) of person who can verify the
advanced nature of the course or program:
Verification
Information:
If you selected MPI PROGRAMS above, answer the following questions:
MPI Program:
If you selected MPI
Online Course or
Other above, please
explain:
PAYMENT Information:
*Payment Due Date:
*Make Check
Payable To:
*Address:
*Contact Name /
Phone / E-mail:
Section IV: About Why You Need This Scholarship
In the space allotted here, please tell us why you need this scholarship:
_______ I attest to the authenticity of the submitted information to the best of my
knowledge.
REMEMBER TO SUBMIT YOUR TAX FORMS.
IMPORTANT: Print or save a copy and then e-mail to CPerry@mpiweb.org