Scholarship Form

Your Partner in Growing Your Community

Scholarship Form

Full Name*

Title*

Organization*

Address*

City*

State*

Zip*

Phone*

Fax

Email*

What training/program will the scholarship be used for? (If info online, you may paste a URL. If not, scan and email info to meda@medaweb.org or mail it to MEDA, P.O. Box 10596, Lansing, MI 48901-5096.)

Size of Organization's Economic Development Budget

Years of experience in Economic Development

List MEDA Boards, Committees, or Taskforces you have served on. Include Board/Committee/Taskforce in the first field and Years Served using the drop down menus (limited to maximum of 4 points). Participation must be on MEDA committees/taskforces. Other economic development-relation organizations will not count.

Board/Committee/Taskforce Entry 1

Entry 1 Years served

Board/Committee/Taskforce Entry 2

Entry 2 Years served

Board/Committee/Taskforce Entry 3

Entry 3 Years Served

Board/Committee/Taskforce Entry 4

Entry 4 Years served

For new members of MEDA (1 year or less), please indicate which committee or taskforce that you will serve for at least a year after receiving the scholarship. Click here for a list of MEDA's current committees and taskforces (page will open in new window).

Committee or Taskforce

How long have you been a MEDA member?*

How will attending this training help you professionally?*

Please enter the characters you see in the box