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Scholarship Application

Scholarship Application

Partial scholarships for Leadership Bloomington—Monroe County are provided by the LBMC Alumni Association with funds raised from members and sponsors. Although we welcome scholarship applications from everyone, submitting an application does not ensure that you will receive financial assistance or the level of financial assistance you request. You will be informed of any scholarship awarded at the same time that you are notified of admittance to the program.

The names of scholarship recipients may be released publicly to promote the benefit of the scholarship program and to aid in fundraising efforts. Please let us know below if you would have any concerns about being publicly recognized in this way. After completing the program, scholarship recipients may also be asked to provide a statement about the benefit of the scholarship for promotional materials. This is not a requirement of accepting a scholarship.

"(* Required)" indicates required fields

Name(* Required)

First Last

Email(* Required)

Employer(* Required)

Position(* Required)

Employer Address(* Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Please provide a breakdown of how you anticipate paying the $1,000 tuition. If you have “other source” funding, please specify below. Please note that funds are limited and that we grant partial scholarships.

Self

Employer

Other source

LBMC-AA scholarship

If an employer contribution is not applicable, please explain.

One of the goals of these scholarships is to provide access to a wide variety of Bloomington and Monroe County citizens. What do you feel you can contribute to the LBMC program and/or alumni association that would be unique and would create a positive impact?

How will not receiving scholarship assistance, or receiving less than the amount you requested, impact you?

If you are awarded a scholarship and do not complete the program, the entire value of the scholarship must be repaid to the LBMC Alumni Association.

Authorization(* Required)

By checking this box, I agree that the above information is correct, and I have not misrepresented my identity

Comments

This field is for validation purposes and should be left unchanged.

Scholarship Application

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