This program is sponsored by the Professional Development Committee of CASE District VI. CASE DISTRICT VI CASE VI Student Scholarship Application for 2012 Joint Conference Application Deadline is July 15, 2012. Resumes are encouraged and can be e-mailed to lewisdi@umkc.edu. ** 75 word min for each question

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 Interest	*	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: i.e. Independent, 2 year, public 4 year, private 4 year, other. And also the number of students enrolled this year.	*
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 Chicago, IL are ineligible to receive the travel stipend. I also understand that I will have to provide a headshot and be listed in conference materials if selected.
Place a checkmark in the box to confirm the above is true.	*