Prairielands CE $400 Scholarship Application
Fiscal Year 2023-2024- Once per quarter
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Name of training/event being applied for:
*
Dates of training/event:
*
-
Month
-
Day
Year
Date
Is this a multi-day event or course? If so, what is the expected completion date?
-
Month
-
Day
Year
Date
Location of training/event:
*
Registration/Tuition Fee:
Transportation:
Lodging:
How many nights of lodging will you require?
Meals:
Substitute:
Parking:
Total Amount Requested(not to exceed $400, must add up to amounts entered above):
For Pioneerland Staff: Should your registration fee be reimbursed to the Pioneerland Office? (If you answer yes, you still need to 1. include it in your scholarship request, 2.send Prairielands proof of registration, and 3. let Pioneerland know they need to send us proof of payment.)
Yes
No
Have you received a Prairielands Scholarship in the past?
Yes
No
If yes, list month and year:
Amount received:
Please type your name in the box below to serve as your virtual signature:
*
Position Title:
*
Employer:
*
Work Phone Number:
Work Email:
example@example.com
Date Submitting Application:
-
Month
-
Day
Year
Date
Submit
Should be Empty: