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"Powering Local Leadership" Travel Scholarship Application
*
1.
Name
(Required.)
First
Last
*
2.
Email address
(Required.)
*
3.
Mailing address
(Required.)
Street address
City
State
Zip
*
4.
Organization name
(Required.)
*
5.
Organization type
(Required.)
Local government employee
Tribal member
*
6.
I confirm:
(Required.)
I will register for one or both days of the summit by January 18.
*
7.
I confirm:
(Required.)
I would likely be unable to attend the summit without this travel scholarship.
*
8.
I will use this reimbursement for:
(Required.)
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
Current Progress,
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