*1.First Name(Required.)

*2.Last Name(Required.)

*3.Title(Required.)

*4.City of(Required.)

*5.City Mailing Address(Required.)

*6.City(Required.)

*7.Postal Code(Required.)

*8.Daytime Phone(Required.)

*9.Email Address(Required.)

*10.Please identify which costs you are requesting be covered (select all that apply)(Required.)

Registration Fee ($65)

Lodging (2 day maximum)

Travel Expenses ($50 maximum)

*11.Will your city send other officials to this year's City Day at the Capitol?(Required.)

Yes

No

Unsure

*12.Have you ever attended City Day at the Capitol?(Required.)

Yes

No

Unsure

*13.Will you be able to attend City Day at the Capitol if you do not receive a scholarship?(Required.)

Yes

No

Unsure

*14.Which LOC region is your city in? If you are unsure, please see the provided map of regions.(Required.)

1

2

3

4

5

6

7

8

9

10

11

12

*15.LOC, in adopting its Equity Lens, committed itself to create an inclusive environment where everyone who belongs to the LOC and aspires to be associated with the LOC, knows that the LOC is a place that is welcoming, helpful, and resourceful. The Equity Lens acknowledges and understands that segments of our communities have been historically underserved or ignored. Please see the Equity Lens's non-exhaustive list of diverse populations and historically underserved community members.

LOC strives to honor the diverse backgrounds of all its members and, if you are comfortable doing so, in the space below, you are welcome and encouraged to share any and all diverse and underserved communities you identify with as a person.(Required.)

*16.In the space below, please describe your need for the scholarship and how attending the League of Oregon Cities Conference would benefit you as a local government official.(Required.)