2017 NAMA SCHOLARS APPLICATION Question Title * 1. Personal Information Name: Title: Phone: Email: Question Title * 2. What is your gender? Female Male Question Title * 3. Are you currently a full-time employee of a NAMA member company in good standing? Yes No I don't know Question Title * 4. Have you been in the convenience services industry for 5 or more years? Yes No Question Title * 5. Please list any advanced degrees and/or industry certifications that you hold currently. Question Title * 6. Please select any of the following NAMA special interest groups or committees of which, you personally, maintain active involvement. Emerging Leaders Network (ELN) Women of the Industry (WIN) NAMA or NAMA Foundation Committee or Task Force Other (please specify) Question Title * 7. Company Information Company: Company Address: City, State, ZIP: Question Title * 8. Member Type Operator Broker Distributor Equipment Manufacturer International Supplier Sustaining Question Title * 9. Please list the name/s of any State Council where you are actively involved. Question Title * 10. Do you hold a leadership position in any of the State Councils in which you participate? Yes No Question Title * 11. Please describe how the NAMA Executive Development Program would assist you in achieving your short & long-term professional development goals. (300-500 words max.) Letter of Recommendation Please send a letter of recommendation from your manager to Tbruce@namanow.org by July 7, 2017. The subject line in your email should be: Your First and Last Names/ NAMA Scholars Letter of Recommendation. SubmissionIn submitting this form, I acknowledge that the information contained in this application is accurate and completed to the best of my knowledge. Submit