The Karen McQuillan Memorial Fund Application Form
The Karen McQuillan Fund, honoring RESULTS’ first coordinator for U.S. poverty advocacy groups, was established in
1998 to assist low-income RESULTS partners based in the United States to participate fully in RESULTS activities. The
goal is to provide financial support for those who would otherwise be unable to participate due to costs.
Unfortunately, the number of scholarships we can award is extremely limited, and early application is
encouraged.
Application deadline: April 15, 2013
All decisions on recipients will be made by April 24, 2013.
Return application to:
Lisa Marchal, Senior Global Grassroots Associate
940 Woodruff Middle Dr. #6, Indianapolis, IN 46201
lmarchal@results.org
Questions? Contact Lisa Marchal at (317) 529-5182.
To Apply:
1. You must be an applicant with high financial need. Strong preference will go to first-time International
Conference attendees who have been active with RESULTS USA for at least 4 months. Contact Lisa Marchal if
you are unsure whether or not you are eligible.
2. Fill out the following questionnaire in complete detail. (Feel free to type your application on a separate sheet or send it
by e-mail, but please answer all the questions.)
3. All information listed on this application will be kept confidential between you and RESULTS staff members
processing your request.
Your Name: ________________________________________________________________________________
Address: ___________________________________________________________________________________
City: _______________________________________
State: _____________________ ZIP: ______________
Phone: (home) _______________________________
Email: _______________________________________
RESULTS Group/Free Agent: ___________________
Check one: Global ___ Domestic ___
1) What are your current roles and activities in RESULTS?
2) Have you attended an International Conference before? YES
NO
3) If you have attended a RESULTS conference before, what has been the impact of it/them on your RESULTS
experience?
4) What skills, information, or other benefits do you hope to take away from the International Conference this
year?
5) How do you plan to continue your participation with RESULTS?
6) Have you received support from the McQuillan Fund in the past? Circle one: Yes No
If yes, what year(s)?
7) Cost Estimate for your trip to the conference:
Flight:
Hotel:
Ground transportation:
Food:
Other incidentals:
Total:
Your need from this total :
Annual household income: $ _______________________
8) Because KMF awards are very limited and generally do not cover all expenses, what other plans/efforts have
you made or are you planning to make to ensure you can attend the conference?
9) Any other information that would be helpful for us to know?
Thank you for your application!