Chapter President’s Council

Scholarship Application Form

2015

Applicant Affidavit:

By submitting this application to the GBTA Chapter President’s Council (“CPC”) Scholarship Committee for consideration, I affirm that all information provided is true and can be substantiated with additional documentation, if requested. I understand that submission of false information or failure to provide sufficient documentation shall invalidate this application and will result in the termination of any scholarship aid now or in the future. I have read and understand that a member can only earn a scholarship once every two years.

Applicant Information:
Name:
Title:
Company:
Local Chapter/Affiliate:
Telephone Number:
Email Address:
Address:
# of Years as a Local Chapter/Affiliate Member (You must be a current member in good standing of a local GBTA chapter/affiliate in order to be considered for a CPC scholarship)
Please submit a current photo. By attaching a photo, you consent to the use of the photo in CPC presentations and on the website as part of the announcement, if you are awarded a scholarship.
Qualification Information:
Please answer the questions below in the boxes provided. Boxes will expand as needed.
1.  Please describe your past and present involvement in your local chapter/affiliate, including positions held (i.e. committee chair, committee volunteer, Board Member, Officer etc). Up to 20 points awarded
Scholarship Type:
Please indicate to which program or event you would be applying scholarship funds. Further information on each program can be found online under the education section at www.gbta.org/cpc.
Program (i.e. Legislative Summit, GBTA Convention, GBTA Membership Fees, etc) / $ Amount Requested
2.  Please explain in detail how you would use the scholarship money and how it would contribute to advancement in your career. (Essay – Please limit your answer to 500 – 700 words) Up to 80 points.
Completed applications must be received before deadline in order to be considered. Please return this application along with your photo to
Deadline for submission is close of business, March 13, 2015.

Applicant # _____ Page 1 February 19, 2015