Grants Professionals Association Miami Valley Chapter MEMBERSHIP SCHOLARSHIP APPLICATION The MVGPA membership scholarship fund was established to help members obtain GPA membership. The following criteria are required for scholarship consideration. MVGPA will not pay membership dues to another organization. Awards will be prioritized to members who demonstrate financial need. Awards will be determined according to MVGPA financial limitations. Awards will not exceed National’s fees. Recipients are required to become a member of the MVGPA chapter and are responsible for paying the chapter fee. Awards to a repeat recipient will following a “weaning off” process: o First award at 100% of membership costs o Second award at 75% of membership costs o Third award at 50% of membership costs o Fourth award at 25% of membership costs o No fifth awards will be made. At this time the member is ineligible for any future membership scholarship awards. Recipients will agree to attend a minimum of 50% of Chapter meetings. Recipients will agree to serve on an MVGPA committee of their choice. If scholarship recipients are non-compliant with the above-stated requirements of their award, they are no longer eligible for any future scholarship awards from MVGPA, to include both membership and conference scholarships. The MVGPA Board of Directors has the final decision on all applications. Please tell us about you: NAME ________________________________________________________________ POSITION: ____________________________________________________________ ORGANIZATION: _______________________________________________________ ADDRESS: ____________________________________________________________ CITY/STATE/ZIP: _________________________________FAX #:________________ WORK PHONE #:___________________ HOME/CELL PHONE #: ________________ EMAIL ADDRESS: ______________________________________________________ My agency (please check only one): ______ DOES pay for GPA dues ______ DOES NOT pay for GPA dues Have you received a membership scholarship from MVGPA in the past? (Circle only one.) YES NO If yes, in what year? ___________________ Please tell us your reason for requesting this scholarship. Attach a separate page if necessary. _ _ __ _____ _ _____ _ ___ _ _ ___ _____ ________________________________________________________ _ ___ ________________________________________________________________ ___ ______________________________________________________________ _ ___ _____________________________________________________________ _ ___ ________________________________________________________________ _____________________________________________________________________ If awarded, I understand that I am responsible for paying the fee to become a member of the Miami Valley Chapter. I agree to attend a minimum of 50% of Chapter meetings and serve on an MVGPA committee of my choice. I understand that if I am not compliant with these requirements, I will not be eligible for any future scholarship awards from MVGPA. _________________________________________ Signature ________________ Date Return this form to: Andrea Hoff, MVGPA President 451 West Third Street, 9th Floor Dayton, OH 45422-3100 Phone (937)496-7622; Fax (937)496-7714 [email protected] =============================================================== BOARD ACTION: THANK YOU FOR YOUR REQUEST - IT WILL BE CONSIDERED AT THE NEXT MVAAGP BOARD MEETING. IF APPROVED, YOU WILL RECEIVE A WRITTEN NOTICE OF APPROVAL.