Course Scholarship Application

All fields with a * are required.

If you are unable to complete this form online, you can mail in our hard copy version.

Participant Information

First Name *

Last Name *

Title *

Agency/Organization *

Department/Division *

Address *

Address 2

City *

State *

Zip Code *

Phone Number *

Fax Number

Email Address *

Additional Information

Total Number of Employees in Your Agency/Organization *

Total Number of Employees in Your Department/Division *

Please list the course(s) and date(s) for which you are requesting tuition assistance *

Please describe your financial need. *

(Please be as specific as possible.)

How much is your agency/organization able to contribute from internal sources? *

Please describe how the course(s) would help your job performance. *

If you belong to any of the professional associations listed, please select them below. *

Seattle Management Association

Washington City/County Management Association

Washington City Planning Directors Association

Washington Finance Officers Association

Washington Public Ports Association

Washington State Association of County and Regional Planning Directors

Other

None

Additional Information or comments that might be helpful for the review committee.

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