<p> AFP Foundation 2015 Chamberlain Scholarship Program</p><p>Application Deadline: October 10, 2014</p><p>Applications must be submitted to Karen Bajza at [email protected] or faxed to her attention at 323.851.1472.</p><p>For more information, contact Karen Bajza at [email protected] or Jeanne Warlick at [email protected] .</p><p>Eligibility Requirements: Applicant must be an AFP member.</p><p>Applicant must be employed as a fundraising professional or, if an executive director, devote a substantial amount of time to fundraising.</p><p>Applicant is required to attest that he or she has never attended an AFP (or NSFRE) International Conference on Fundraising as a registered participant (unless as a member of the Conference Host Committee).</p><p>Personal Data Applicant’s Name Are you a member of AFP? How long have you been a member of AFP? ______Job Title Employer Business Address City State Zip Business Phone Number Home Phone Number Email Address Website URL Supervisor’s Signature ______(or signature of an Executive Committee member on your organization’s board) Phone Number </p><p>Background Information Years in the Profession Previous Training in Fundraising (Please specify courses, seminars, conferences attended)</p><p>Page 1 of 2 Professional Reference (Other than present employer) Phone Email </p><p>Would you be able to attend this year’s conference without a scholarship? Y__ N__ If you answered yes, please provide a brief explanation here:</p><p>Why should you win this scholarship and how will you benefit?</p><p>Would you be willing to share information about your experience at the conference with fellow AFP GLAC members at a chapter meeting? Y__ N__</p><p>Are you willing to commit to completing a post-conference online evaluation? Y__ N__</p><p>I am employed as a full-time fundraising professional or spend at least fifty percent of my time fundraising for my employer. I have never attended an NSFRE/AFP International Conference on Fundraising and understand that only one individual from my local organization can be selected.</p><p>______(Applicant’s Signature) (Date)</p><p>Page 2 of 2</p>