Northwest RPD Scholarship Form
2017 Northwest Rural Philanthropy Days
Rural Philanthropy Days (RPD) is a collaborative statewide program that promotes excellence in Colorado's rural communities. By providing nonprofit leaders the resources they need to lead effective and sustainable organizations, program participants are better able to increase mission impact, build collaborations, and achieve grant funding goals.
- Work for or represent: a 501(c)3 public charity, an organization using a Fiscal Sponsor that is a 501(c)3 nonprofit, a tax-supported or quasi-governmental agency, or a start-up organization that is not yet a 501(c)3 but has filed Form 1023 (application for exempt status)
- Applicant's organization must be based in Grand, Jackson, Moffat, Rio Blanco or Routt County
- Applicant must be able to attend all three days of the conference, September 27 - 29, 2017 in Craig, CO.
*The Northwest RPD Steering Committee will be awarding a total of 15 full scholarships and 20 half scholarships to qualifying applicants with financial need. Scholarships will be divided evenly among all five counties in the Northwest region.
DEADLINE to complete the application is August 1st.
If you are applying for a scholarship, do not yet register for the event! You will be notified of whether or not you have been awarded a scholarship by August 18th. Recipients will then need to register for the conference by August 31st using the discount code that is provided. Applicants that are not awarded will receive a discount code to honor the early bird registration price (discount code will expire September 1st.)
Applicant's Full Name
One application per organization may be submitted.
Address Line 2
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Bosnia and Herzegovina
British Indian Ocean Territory
Central African Republic
Democratic Republic of the Congo
Republic of the Congo
Papua New Guinea
Saint Kitts and Nevis
Saint Vincent and the Grenadines
Sao Tome and Principe
Trinidad and Tobago
United Arab Emirates
United States Minor Outlying Islands
Virgin Islands, British
Virgin Islands, U.S.
Affiliation with Organization
Have you (the applicant) attended a Rural Philanthropy Days conference before?
Yes, I've been to a RPD conference before
No, this will be my first time
County where organization is based:
My organization is:
a 501c3 Public Charity
using a Fiscal Sponsor that is a 501c3 (Please Indicate Below)
a tax-supported or quasi-governmental agency
a Start-Up without 501c3 status, but has filed Form 1023 for exempt status
If using a 501c(3) Fiscal Sponsor, please specify the name of the organization here
IRS Determination Letter or copy of filed Form 1023
Organization's Annual Operating Budget for FY2017:
$49,999 or less
$50,000 - $99,999
$100,000 - $249,999
$250,000 - $399,999
$400,000 - $699,999
$700,000 - $999,999
$1 -2 million
Greater than $2 million
No. of Full-Time Equivalent (FTE) Employees
In 250 words or less, describe why you are requesting scholarship assistance and why you should be selected to receive a scholarship.
If awarded a scholarship, I understand:
1) I am responsible for my own travel and lodging arrangements to and from Craig, Colorado.
2) I am expected and will plan to attend all three days of the conference, September 27 - 29, 2017.
3) I must register for the conference using a discount code that will be provided to me.
4) I will not transfer the scholarship to another person within my organization unless I have written permission to do so from the RPD Event Coordinator or Event Co-Chair.
5) I will not transfer the scholarship to anyone outside of my organization.
6) I will notify the RPD Event Coordinator (firstname.lastname@example.org) at least 7 days prior to the event if I am no longer able to attend the conference or am unable to utilize a scholarship.
7) In the event that I am no longer able to attend the conference, I will provide a replacement from my organization to attend with the scholarship that was awarded.
I have read, understand and agree to the scholarship guidelines above and by clicking the box below, certify that the information in this application is true and correct to the best of my knowledge.
Yes, I agree and certify.
Do Not Fill This Out