Lisa M. Kolodziej Scholarship Application Form

Personal Information:
Your Name and Title
Are You a CEDAS Member? Yes No If No, please submit a Membership Application and evidence of processing of payment in order to be eligible for a scholarship.
Your Organization
Organization Address
Phone		Email
Amount of CEDAS Scholarship being requested, projected costs, and other anticipated sources of funding:
CEDAS Scholarship Being Requested $ (see breakdown below of costs and other sources)
Registration $		Travel $
Meals $		Lodging $
Misc $
(provide details)
Total Costs (approx)
Other Funding Sources
Employer Contribution
Other
Program for which this Scholarship is being requested (include program name, dates and location):

Reason(s) For Scholarship Request:

Print This Page

Personal Information: