"Powering Local Leadership" Travel Scholarship Application Question Title * 1. Name First Last OK Question Title * 2. Email address OK Question Title * 3. Mailing address Street address City State Zip OK Question Title * 4. Organization name OK Question Title * 5. Organization type Local government employee Tribal member OK Question Title * 6. I confirm: I will register for one or both days of the summit by January 18. OK Question Title * 7. I confirm: I would likely be unable to attend the summit without this travel scholarship. OK Question Title * 8. I will use this reimbursement for: Vehicle mileage (to be reimbursed at GSA rate of $.54/mile) [Please estimate round-trip mileage (miles) below.] Public transit [Please estimate round-trip ticket amount ($) below.] Vehicle rental [Please estimate one- or two-day rental amount ($) below.] Estimated mileage or $ amount OK DONE