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* 1. I would like to apply for the following scholarship(s):
(Note: You can select one or both.)

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* 2. Today's Date

Date

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* 3. Applicant's Contact Information

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* 4. Applicant's IAQA Member ID # (if applicable)

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* 5. If selected for the travel award would you be able to attend the Annual Meeting?

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* 6. Did you attend College/University?

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* 7. Current Employer

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* 8. Previous Employer #1

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* 9. Previous Employer #2

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* 10. List IAQ Relevant Certifications you have received:

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* 11. List any volunteer experiences you have had over the past 3-5 years:

Please answer the following statements / questions:

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* 12. Explain to the Scholarship Task Force why you need the scholarship distribution.

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* 13. Explain your IAQ career goals and how receiving this scholarship would help you attain those goals in the IAQ Industry?

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* 14. How do you believe the IAQ industry could be improved?

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* 15. Explain how your market is currently underserved or high-risk related to IAQ topics.

In addition to the above application please attach 2 letters or emails of reference.

You can upload files in the following formats:

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF


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* 16. Reference Letter/Email #1

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

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* 17. Reference Letter/Email #2

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File
I hereby certify that the information provided in this application is true and correct.

By entering your name below you are acknowledging the above statement.

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* 18. Electronic Signature

T