This program is sponsored by the Professional Development Committee of CASE District VI. CASE DISTRICT VI CASE VI New Professionals Scholarship Application for 2011 Conference Application Deadline is October 1, 2010

Applicant Name	*
Professional Title	*
Institution	*
Work Address	*
Telephone	*
Email Address	*
Education Level	*	- Select - Freshman Sophomore Junior Senior Post-Graduate
Length of service in the Advancement field	*	- Select - 6 months 6 months - 1 year 1 - 3 years More than 3 years
Length of service in your current postion	*	- Select - 6 months 6 months - 1 year 1 - 3 years More than 3 years
How many CASE workshops, institutes or district conferences have you attended and what did you attend?	*
Race/Ethnicity	*	- Select - Caucasian American Indian/Alaska Native Asian Black/African American Hispanic/Latino Native Hawaiian/Pacific Islander Multi-Racial
If you wish for your cultural background to be identified, please check one below.		Yes No
Supervisor's Name, Title, Institution	*
What are your current career goals within five and ten years?	*
Define your position within your University advancement team and how this relates to your career goals.	*
How will attending the District VI 2011 Conference help you to achieve your goals?	*
I confirm that this information is true and that all travel and accommodation costs, not covered by the scholarship, will be covered by my sponsoring institution or organization. I also acknowledge that I am interested in pursuing a career in educational advancement. NOTE: Applicants residing in/near the host city of Kansas City are ineligible to receive the travel stipend.
Place a checkmark in the box to confirm the above is true.	*