Request for Scholarship Support to EPIP's 2013 People of Color Gathering

Please take some time to fill out this survey to request scholarship support. Scholarships will be in the form of $250 for travel/lodging AND a waived registration fee (i.e., if you receive travel support, you will receive waived registration as well). If you have any questions, please contact Kate Seely at kate@epip.org. Thank you!

* 1. What is your name?

* 2. Please include primary email address and phone number below.

* 3. Are you an EPIP member?

* 4. With what organization(s) do you work?

* 5. What is your gender?

* 6. Do you identify as LGBT?

* 7. What age group are you in?

* 8. What city and/or EPIP chapter are you located in?

* 9. Are you hispanic or latino? (A person of Cuban, Mexican, Puerto Rican, South or Central
American, or other Spanish culture or origin, regardless of race.)

* 10. How do you describe yourself? (choose one or more from the following groups)

* 11. Statement of need: Why do you need this help to attend the PCN gathering? (Please limit your answer to 300 words.)

* 12. What does it mean for you professionally, and from an identity standpoint, to attend the PCN gathering? (Please limit answer to 300 words.)

* 13. If you didn't receive this support, would you be able to attend?

Thank you for completing the scholarship application for the EPIP PCN gathering!

Applications are being received and reviewed on a rolling basis.

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