Scholarship Requested

Career Success Institute (CSI)
Chamberlain Membership

Name

Job Title

Organization

Business Address

City, State, Zip

E-Mail Address (required)

Business Phone

Number of years in the profession:

Do you currently have an active AFP membership?

Yes   No 

Have you received prior AFP scholarship assistance?

Yes   No

If yes, for which Scholarship?

Career Success Institute (CSI)
ChamberlainMembership

If you are applying for a membership scholarship, which membership category best fits your current situation? 
Please click here for a link with details on each membership level.

  Professional   Young Professional Associate

Have you made a donation to the AFP Every Member Campaign (EMC) this year?

Are you applying for a scholarship because your organization does not cover expenses related to your AFP membership/professional development? If yes, please elaborate. If no, please explain your need. (250 word max)

Please list your current and past AFP committee involvement:

By submitting this application, I acknowledge:

1. To the best of my knowledge and belief, the information submitted in this application is correct.

2. I meet the eligibility requirements as outlined in the Scholarship Application Criteria and any criteria specific to the award for which I am applying.

3. If I receive scholarship my name and organization may be published in the chapter newsletter and/or annual report.

4. For Membership applications only, I agree to pay the $35 chapter dues should I receive a Membership Scholarship.