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

Applicant Name	*
Title	*
Institution	*
Work Address	*
Telephone	*
Email Address	*
Education Level	*	- Select - Freshman Sophomore Junior Senior Post-Graduate
Volunteer Experience in the Advancement Field	*
Areas of Experience	*	Advancement Services Alumni Communications Management Philanthropy
Length of Experience	*	- Select - 6 months 6 months - 1 year 1 - 3 years More than 3 years
Advancement Career Goals	*
Have you attended any CASE workshops, institutes or district conferences?	*	- Select - Yes No
Type and Dates of attendance	*
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
Sponsor's Name, Title, and Institution	*
What would you like to accomplish by attending this conference?	*
Why are you interested in a career in educational advancement?	*
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.	*