SCTE Foundation Grant Application

Full Name *

Member Number *

Title *

Company *

Address Line 1 *

Address Line 2

City *

State *

Zip *

Country *

Email *

Phone *

Choose Program for requested funds *

Please provide the cost, location, and date that course begins *

Cost of Program or Classes *

Grant or Scholarship amount requested *

Does your employer offer educational assistance? *

Yes

If yes, please state the dollar amount awarded

If you have NOT applied, please state your reason(s)

Have you applied for financial assistance from an organization(s) other than your employer? *

Yes

If YES, please list the following: 1. Organization(s) to whom you have applied; 2. Amount of the grant(s) for which you have applied; 3. The amount awarded

Please list your professional organization memberships, notable contributions to the industry and other professional activities with dates of involvement

Please describe why you wish to pursue this funded activity and what the anticipated benefit will be. Please add additional pages as necessary.