Prairielands $1000 Scholarship Application
Fiscal Year 2024-2025 Once per year (July-June)
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:
*
Is this location considered a high-cost locality by the IRS? (MN locations do not count)
*
Yes
No
Registration/Tuition Fee:
*
Proof of payment will be required
Transportation:
*
Mileage in a personal vehicle= 70 cents/mile
Lodging:
*
Proof of payment will be required.
How many nights of lodging will you require?
*
Meals:
Enter how many meals of each type you will need coverage for. Please note the specification for each meal and where it will be purchased as our per-diem travel policy reflects the state values, which differentiate by meal period and by location.
Meal Count: List the NUMBER of each meal needed.
Meals in MN or an average cost city B: $11, L: $13, D: $19
Meals in an IRS-defined
high-cost locality B: $12; L: $15, D: $23
Breakfast
(If departure from work address is before 6am, or if following an overnight stay)
Lunch
(35+ miles from work address; working over normal lunch hour)
Dinner
(away after 7pm or overnight)
Total dollar value of meal periods:
*
For example: 2 average cost location breakfasts (2 x $11), one average cost dinner (1 x $19) and 1 average cost lunch (1 x $13) would be a total of $54.
Substitute:
*
Parking:
*
Proof of payment will be required.
Total Amount Requested(not to exceed $1000, 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:
*
Submit
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