March 25-27, 2009 by 1fMrH76

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									                                       Scholarship Application
 Scholarships are provided through the generous support of sponsoring institutions of the Gulf-South Summit.

Deadline: Dec. 10th, 2010, 5 p.m. Email form to Betsy Hart, edhart@ualr.edu.
The Gulf-South Summit is offering conference scholarships in the form of hotel accommodations and/or registration. The
Gulf-South Summit Scholarship Committee, with the approval of the conference coordinator, is responsible for deciding
who receives scholarships and how much is awarded.

Scholarship recipients will receive instructions for registering and reserving hotel rooms with the assistance of the
Conference Coordinator.

Please type or print
Name of applicant:


Address:


Institution or
Organization:
Department/Office:


Phone:                                           Email:                                Fax:




Indicate if you are:     _____ Faculty      _____ Staff/Administrator     _____ Student       _____ Community Partner
Are you leading or assisting with a conference session? _____ Yes        _____ No

Briefly describe how you are involved in service-learning and/or civic engagement.

Indicate the amount you are requesting:

                               nd
Room Fee Waiver for March 2 @ $129
                              rd
Room Fee Waiver for March 3 @ $129
Registration Fee Waiver
(Regular: $225 / Student or Partner: $175 / Participant from Sponsoring Institution: $200)
Total Request
Please explain briefly (limit to 200 words) why you are requesting a scholarship to attend the Gulf-South Summit (for
example, your interests in service-learning, new to the field, scholarly pursuit, financial need, impact from conference
expected for you, your program, institution, curriculum, community setting, or affiliation with existing programs).

								
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