2018 SE RPD Scholarship Application
A limited number of scholarships are available to qualifying applicants with financial need to cover the total registration cost of attending the 2018 Southeast Rural Philanthropy Days.
IF YOU ARE APPLYING FOR A SCHOLARSHIP, DO NOT REGISTER FOR THE EVENT!
To apply, complete the online application form below. Priority deadline for the application is April 30.
● 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 I.R.S. Form 1023 (Application for Recognition of Exemption)
● Applicant’s organization must be based in Baca, Bent, Crowley, Huerfano, Kiowa, Las Animas, Otero or Prowers Counties.
● Applicant must be able to attend all three days of the conference on June 13-15, 2018 in Prowers County, Colorado.
Selection will be based upon one or more of the following criteria:
● County where organization is located
● Financial need
● First-time conference attendee
● Involvement in SE RPD Steering Committee
● Organization size
● Quality and completeness of the application
Other Items to note:
● Only one application will be considered per organization
● The Scholarship Committee plans to award 20 scholarships between the eight counties within the region.
● Scholarships will cover the cost of conference registration only
● Scholarship recipients will be responsible for their own travel and lodging arrangements and additional meal costs
● Scholarship recipients will be notified whether or not they will be receiving an award the week of May 14. Recipients will then need to register for the conference using a discount code that will be provided.
● Applicants that are not selected but apply by April 30 will receive a discount code honoring the early bird registration price.
Priority consideration will be provided to online applications received by April 30.
Questions? Please contact the Southeast Rural Philanthropy Days Event Coordinator, Kaye Kasza at firstname.lastname@example.org or 719-688-2299.
Applicant's Full Name
Address Line 2
State / Province / Region
Postal / Zip Code
Antigua & Barbuda
Bosnia & Herzegovina
British Indian Ocean Territory
British Virgin Islands
Central African Republic
Cocos (Keeling) Islands
Congo - Brazzaville
Congo - Kinshasa
French Southern Territories
Heard & McDonald Islands
Hong Kong SAR China
Isle of Man
Macau SAR China
Northern Mariana Islands
Papua New Guinea
São Tomé & Príncipe
South Georgia & South Sandwich Islands
St. Kitts & Nevis
St. Pierre & Miquelon
St. Vincent & Grenadines
Svalbard & Jan Mayen
Trinidad & Tobago
Turks & Caicos Islands
U.S. Outlying Islands
U.S. Virgin Islands
United Arab Emirates
Wallis & Futuna
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
County where organization is based:
My organization is:
a 501c3 Public Charity
using a Fiscal Sponsor that is 501c3 (please indicate who 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 501c3 Fiscal Sponsor, please specify the name of the organization here:
IRS Determination Letter or copy of filed Form 1023
Organization's most recent annual operating budget:
$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
Number 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.
How many people from your organization will be attending?
If awarded a scholarship, I understand:
1) I am responsible for my own travel and lodging arrangements to and from Lamar, Colorado.
2) I am expected and will plan to attend all three days of the conference, June 13 - 15, 2018.
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 (SoutheastRPD@gmail.com) if I am no longer able to attend the conference or am unable to utilize a scholarship.
7) I am the only person from my organization applying for a scholarship to attend SERPD.
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