Scholarship Application for Minority Advancement Professionals and New2CASE Scholarships

Please print this form and fax or mail as indicated below.

I am applying for: Minority Advancement Professional Scholarship New2CASE Scholarship

List your Institutional CASE ID number (either 5 or 6 digits) _______________ (You can obtain your Institution ID by checking with the Institutional Membership Representative or by calling CASE at (202) 328-2273)

Name:	______________________________________________________
Title:	______________________________________________________
Institution:	______________________________________________________
Address:	______________________________________________________
City: State: Zip:	______________________________________________________
Telephone:	______________________________________________________
E-mail:	______________________________________________________

Gender:	Female Male

Education:	(check highest level):
	High School Associate's Degree Bachelor's Degree
	Master's Degree Doctoral Degree
	Other (specify) _______________________________________

Total length of service in educational advancement: ______________________________
Length of service in your current professional area: ______________________________

Please check the following that best describes you:
	African American Asian Caucasian Hispanic Native American Other (Specify) ____________________________

Please note: Either you or your institution must be prepared to fund any expenses not covered by your scholarship. Please have your supervisor complete Option A below if the institution will cover your expenses. Or if you will be paying for your additional expenses, you must complete Option B below.

Option A: Institutional Endorsement: Our institution will fund the applicant's conference expenses beyond the travel scholarship. I support this application.
Supervisor's Name: _____________________________________________________
Supervisor's Title: ______________________________________________________
Supervisor's Signature: ___________________________________________________

Option B: Applicant's Statement: I plan to cover these costs as an investment in my own professional development.
Applicant's Signature: ____________________________________________________

Have you remembered: Your essay? Your resume? A short statement from your supervisor? Your supervisor's signature on your application? Additional data sheet?

Please send to: Tres Mullis Associate Dean for Development Peabody College, Vanderbilt University Peabody #161 230 Appleton Place Nashville, TN 37203-5721 Fax: (615) 343-7972 tres.mullis@vanderbilt.edu