Learning to Lead: Center for Nonprofit Leadership


Tuition Assistance Form


 
First Name:
Last Name:
Address Line 1:
Address Line 2:
City:
State:
Zip Code:
Home Phone #: (ex: 516-877-1234)
Work Phone #: (ex: 516-877-1234)
Email Address:

Tuition for Learning to Lead will be paid in whole or part by
(check all that apply):

Applicant
Organization or Sponsor

 

If all or part of your tuition will be paid by an organization or sponsor, please provide the following information:

 
Organization / Sponsor Name:
Contact Person at the Organization
Address Line 1:
Address Line 2:
City:
State:
Zip Code:
Phone #: (ex: 516-877-1234)
Email Address:


Comments:


Scholarship Information

If you are applying for a scholarship, provide a 250 word maximum statement as to why scholarship is essential to your participation.



Acceptable file formats: .doc, .txt, .rtf

Please note the amount of support you will be receiving, if any, from your organization or sponsor and indicate whether your participation in Learning to Lead is conditional on receiving a partial scholarship award. Applicants requesting scholarships will be contacted by program staff for additional information.

Specify the scholarship amount you are requesting :

N/A
$500
$1000
Other

If other, please specify:

Will you be able to participate in Learning to Lead if you do not receive the requested scholarship assistance?

Yes
No






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Contact
 For additional information, please contact:

Diane Wunderlich
Program Coordinator
Center for Nonprofit Leadership
p - 516.877.4415
p - 516.877.4390
e - dwunderlich@adelphi.edu
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