Professional Development
Scholarship Grant Application Form
Current applications must be received by September 17,2004.
How would you like us to respond to you?:
Email
Telephone
Mail
Full Name:
Title:
Company Name:
Address:
City/State/Zip/Country:
Work Phone:
Home Phone:
Fax:
E-mail:
Year Graduated:
Degree:
Years of Experience:
Past five years of professional work. Highlight contributions to the industry:
What skills would you like to develop:
How will this training be applied toward your career development in the future?
Reason for applying for grant: (List at least three objectives of the training you are applying for):
List the communication industry associations you are active in and note any leadership positions held, committee assignments or other information which may distinguish you:
Indicate the followup activity you will perform to fulfill the grant conditions:
Written evaluation of how the seminar/course of instruction was applied in your job or career.
Report of manager/supervisor of the instruction on your effectiveness on the job.
I attest that the information provided on this grant application is true and accurate to the best of my knowledge, and that I will provide all required documentation in a timely manner.
Application Date:
Applicant Signature:
If you choose to mail this Application Form, send it to:
The Webb Foundation
Inez W. Wehrli, Administrative Director
P.O. Box 950, Locust Grove, VA 22508
(540) 972-5222 Fax (540) 972-5223 Email:
info@webbfoundation.org
URL:
http://www.webbfoundation.org/