Call for JCEP Leadership Chapter Scholarship Application for Professional Improvement

ESP Chapter Awards Application/Nomination Form

Applications must be received by: DECEMBER 1, 2018BY 5:00PM EDT

Send completed form to:ith “JCEP Scholarship” in the subject line.

Purpose: To financially assist Agents wishing to attend the JCEP Leadership Conference. The scholarship funds in the amount of $400 will be dispersed at the completion of conference.If awarded a scholarship, you will be responsible for submitting a “Scholarship Report Form” with proof of expenditures. This form will be sent to scholarship winners.To be eligible for ESP – Alpha Delta ChapterESP scholarships, you must be an active ESP member and must have contributed to the ESP High Five Campaign.

Please note that there are several other national scholarships and mini-grant sources from National Epsilon Sigma Phi described at: choose tab(s) Scholarships and or Grants.

Applicant Information
Full Name: / Title: / Date Submitted: 00/00/00
Office Address:
City, State, ZIP:
Office Phone: / Cell Phone: / Email:
Year Initiated Into ESP: / Years of Extension Service:
Award Information
Have you been able (or at least attempted) to secure travel funds from other sources first (County, DED, grant, other agents’ association)? (Yes or No) If yes, how much and from what source(s)?:
Have you ever been an ESP scholarship recipient? (Yes or No)
Have you attended the JCEP Leadership Conference previously? ______(Yes or No)
Have you been or are you currently an ESP officer, committee chair or other leadership position within ESP? (Yes or No) If yes, what position and for how long?
Have you submitted an abstract to present at the JCEP Leadership Conference? ______(Yes or No)
If Yes, please indicate which of the following presentation options you selected. If No, please indicate which of the following presentation options you plan to submit an abstract for (check all that apply):
Right-click on the check box, click “Properties” and select “Checked” under “Default Value” to select item below
Oral Presentation
Round-Table Discussions
Ignite Sessions
Other:______
Please explain how your participation in the JCEP Leadership Conference will benefit ESP and/or further your own professional development (250 words max.)?

Please save the file using the following convention: Award name, applicant’s last name, applicant’s first name.doc. Example: Tom Jones applied for this scholarship. He would save the file as: JCEPscholarship.Jones.Tom.doc. Send completed form to: ith “JCEP Scholarship” in the subject line.

Judging Criteria:

For Member Service Committee Only

Yes or NoYesNo / Only members who have paid their dues for the current and previous year by membership deadline dates will be considered for scholarship support (Check with ESP Treasurer) If “No”, applicant is disqualified from receiving a scholarship.
Yes or NoYesNo / Contributed to ESP High Five Campaign (Check with ESP Treasurer) If “No”, applicant is disqualified from receiving a scholarship.
0-5 _____ / Use of funds directly supports ESP, applicant’s Extension programming, or applicants professional development (0 = does not directly benefit ESP or applicant in any way; 5 = greatly benefits ESP or applicant’s extension work or individual leadership)
Yes or NoYesNo / Previous award recipient (Yes = 0 points; No = 1 point)
Yes or NoYesNo / Previously attended JCEP Leadership Conference (Yes = 0 points; No = 1 point)
Yes or NoYesNo / Sought funding from other sources (Yes = 1 point; No = 0 points)
Yes or NoYesNo / Submitted an abstract presentation (Yes = 1 point; No = 0 points)
Yes or NoYesNo / Abstract accepted (Yes = 1 point; No = 0 points) Member Services Chair will have to follow up with award applicants
Yes or NoYesNo / Held leadership position for ESP (Yes = 1 point; No = 0 points)