Personal Information

First Name* Middle Name Last Name*
Job Title* Job Role*  
Email* Work Phone*  
Gender* Race* Are you of Hispanic/Latino origin?*

Contact Information
Organization Name* Organization Type*  
Work Address 1* Work Address 2  
Work City* State* Work Zip*
Work Country*    

Additional Information
Which scholarship are you interested in applying for? (Awarded based on availability.) Check all that apply:
Full Conference
NGen and Conference
PPAI and Conference
NGen Only
Which travel statement applies to you? *  
Are you a first time attendee of the Independent Sector Conference?*  
How did you hear about our scholarship program?*  
Birth Year? This information will not be shared.*
Do you have special dietary needs?*
Pursuant to the Americans with Disabilities Act, do you have special needs or require assistance?*

Please indicate your interests below. Check all that apply.
Arts, Culture, and Humanities
Civil Rights, Democracry Building and Advocacy
Community Improvement and Capacity Building
Environment and Animal-related
Health (including mental health)
Housing and Shelter
Human Services
International, Foreign Affairs and National Security
Mutual and Membership Benefit
Network Building and Engagement
Racial Equity, Diversity and Inclusion
Social Science
Technology, Data, and Evaluation

Short Answers

Please complete respond to the following questions. You have the option to either upload and attach your response or copy and paste it into the box below.  The recommended word count is 200-500 words.
Option A: Attach your short answer responses here:  

Option B:

Briefly describe your need for a scholarship, why you are interested in attending, and how you plan to use and share lessons learned at the conference to strengthen your organization’s and the broader nonprofit community’s effectiveness.
Describe your interest and intention to make connections and build networks both with other scholarship recipients and other conference attendees.