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WEC 2012 Conference Registration Scholarship Application
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.
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 of
* Employment Status: 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 number of
* Employment Status: 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
Please submit the following as part of your application. A 300-350
word essay which tells the committee about yourself, describes
the program and provides your reason for selecting.
For example: 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 MPIF; and 3) How you plan to
*Your Goals: contribute to the Meeting and Events Industry.
*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
Certification? sponsoring 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 Are Applying for This
Scholarship
In 300 words or less, please explain to the committee why you are applying for this
scholarship and how you plan to use your knowledge gained to further advance the
Meetings and Events Industry.
_______ 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