Application Form - Scholarship Grant

Humanitarian Scholarship Application
Read and follow all instructions carefully prior to submitting your application. All winners will be notified by email.
I. Personal Data:
Full Name *

Prefix First Name Middle Name Last Name Suffix
Birthdate: *

Month Day Year
Mobile No. : *

Area Code Phone Number
E-mail : *
Where the confirmation will be send to
Home Address : *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
APMA Member #
Membership must be active to be considered for humanitarian scholarship
What do you hope to accomplish?

0/300
Where will the project take place?
City & Country
Proposed Service Date (Start)

Month Day Year
Proposed Service Date (End)

Month Day Year
Estimated Expenses
Transportation, Lodging, Food, Etc.
II. Essay
Your essay should be 300-500 words. You should address in your essay: your goals and choice of humanitarian project, what you intend to do, estimated costs/expenses, service dates and length of time, as well as why a scholarship is important to you. Include any personal characteristics, or experiences that make you uniquely worthy of scholarship consideration.
Essay:

0/500
III. Applicant's E-Signature
By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.

Due to IRS regulations, IPMA scholarship award funds will be granted as reimbursements. To receive the reimbursement, award winners will need to turn in receipts to IPMA. The IPMA Board also requires a written report and photo documentation of humanitarian service rendered using these funds. Winners agree that IPMA may use this information as well as photos on the IPMA website, social media, press releases, and other promotional means and uses.
E-Signature: *
Should be Empty:

Humanitarian Scholarship Application

I. Personal Data:

II. Essay

III. Applicant's E-Signature