CPC INDIVIDUAL SCHOLARSHIP APPLICATION

Name:
Company Name:
Title:
Address:
City, State Zip:
Telephone: (999) 999-9999
Fax: (999) 999-9999
E-Mail:

1. Years in Industry:

2. Years NBTA Chapter Member:

3. Designations (CTE, CCTE, GLP, etc.)

4. Industry, NBTA and Chapter Activities (Officer, Committees, Speaker, Instructor, etc.)


5. Accomplishments, Awards and Certifications


6. Describe your responsibilities as they relate to staff supervision, budget, policy, negotiations and other areas Accomplishments, Awards and Certifications


7. Please describe your professional goals and how this scholarship will help you attain them.


Applicant Affidavit:

I certify that all information provided is true and if requested, proof will be submitted. Failure to provide documentation shall invalidate this application and result in termination of any aid granted.

Applicant's Name:
Date:

Deadline for Submission: Friday, May 8, 2009

***All scholarship funds must be used within two years from date of scholarship award letter. Awards not claimed within this time will be forfeited***