Scholarship Application

Name:
Title:
Organization:
Address1:
Address2:
City:
State:
ZIP Code:
For which course will this grant be used? Please also indicate the program.
Are you a member of APRA International?	Yes No
Are you a member of APRA-MD?	Yes No
Previous APRA-MD Scholarship Recipient?	Yes No
If yes, indicate year(s) and class(es):
Length of time in current position:
Length of time in fundraising field:
Brief description of current position:
Supervisor's Name:
Supervisor's Title:
List some of your professional and/or volunteer activities:


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