CEIA Academy: MCEIA Leadership Development Fund Application Survey

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CEIA is pleased to recognize the Midwest Cooperative Education and Internship Association (MCEIA) as a proud supporter of the CEIA Academy. Region 4 Active Members (Midwest states - Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Ohio, and Wisconsin) are eligible to apply for a registration scholarship to participate in a CEIA Academy - LAUNCH Program. The scholarship will cover the cost of the registration fee for the CEIA Academy - LAUNCH training session. Awardees will be responsible for all other costs to attend (i.e. transportation, hotel, etc.).

1.Contact Information:

Name:

Title:

Organization:

City, State:

Email:

Phone:

2.Are you an active/current member of CEIA?(Required.)

Yes

Unsure

Comments:

3.Are you a CEIA Region 4 Member from the Midwest (Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Ohio, or Wisconsin)?(Required.)

Yes

Comments:

4.How will this scholarship assist you in attending the CEIA Academy - LAUNCH?(Required.)

5.Describe your current professional role, number of years in the field, and ways you hope to develop your leadership skills.(Required.)

6.Have you attended other professional development programs, and if so, how have you benefitted from attending sessions?(Required.)

Yes

If Yes, how have you benefitted from attending sessions?

7.How did you hear about the CEIA Academy - LAUNCH?

8.Are there any other comments you would like to offer to help us understand your desire to attend this year's CEIA Academy - LAUNCH offering?