Ellevate Louisiana Membership Scholarship Application Form

Name

First NameLast Name

Email

example@example.com

Cell Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Occupation/Title

Business/Organization

Industry

Where did you learn about Ellevate Louisiana?

In 3-5 sentences, please share your interest in joining Ellevate Louisiana.

Why are you seeking financial assistance?

Have you sourced other avenues to sponsor your membership costs? (i.e., personal mentor, employer, etc.)

What region of the state are you currently located?

Political Party: As a cross-partisan organization, we value diversity and aim to have a balanced representation from multiple political parties. In order to maintain our cross-partisan stance, we kindly ask for members to share their political affiliations. This helps us ensure that our organization remains inclusive and respectful of various perspectives. *Please note that this information is confidential.*

Please share with us any leadership or community activities you have participated in. This can include religious, industry, or community activities or organizations.

Identify any personal attributes, skills, or experiences that may be beneficial to Ellevate Louisiana.

Scholarship recipients are required to attend one Ellevate LA event in person and serve on, and actively participate in, at least one Ellevate Policy Committee or Ad-Hoc committee for the duration of the scholarship period. Are you willing to make that commitment? Please make your committee selection(s) in the following questions below.

Identify which Ellevate Committee(s) you would be most interested in serving on. Please review our website for further information on our committees.

Please provide a reference from an Ellevate LA member.

Name: First Name   Last Name
Organization:Business Name
Email:   Email