NE Community Deliberation Scholarship Application
Please complete the form below to apply for a half scholarship to the upcoming Northeast Rural Philanthropy Days Community Deliberation Event.
By completing the application, you are agreeing to the following terms and conditions:
1) I am responsible for my own travel and lodging arrangements to and from this event
2) I am expected and will plan to attend the event to which I receive a scholarship.
3) I must register for the event online using the discount code that will be provided to me and am responsible for paying the remaining registration balance.
4) I will not transfer the scholarship to another person within my organization unless I have written permission to do so from the NERPD Interim Committee.
5) I will not transfer the scholarship to anyone outside of my organization.
6) I will notify the NERPD Interim Committee if I am no longer able to attend the conference or am unable to utilize a scholarship.
Please contact Andrea Swan at email@example.com with any questions regarding scholarship applications.
Applicant's Full Name
Affiliation with Organization
Have you (the applicant) participated in Rural Philanthropy Days before?
Yes, I've been to an RPD conference before
Yes, I've served as an RPD steering committee member
No, I have not participated in RPD programming
County where organization is based:
My organization is:
a 501(c)3 Public Charity
using a Fiscal Sponsor that is a 501(c)3 (Please Indicate Below)
a tax-supported or quasi-governmental agency
a Start-Up without 501(c)3 status, but has filled Form 1023 for exempt status
If using a 501(c)3 Fiscal Sponsor, please specify the name of the organization here:
Organization's Annual Operating Budget for FY2018:
$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.
What do you hope to learn and how would this information be of value to you and your organization?
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