2016: Class 11 Grant Application

CONTACT INFORMATION
NAME:
(Last)
POSITION:

(First)

(Middle)

COMPANY/ORGANIZATION:
BUSINESS ADDRESS:
(# Street/Suite)

(City/State)

(Zip)

BUSINESS PHONE:
BUSINESS E-MAIL:
GRANT REQUEST
C-Change tuition cost is $3300, payable in full upon acceptance into the program. Grants
are available up to and including $1,300 per participant.
AMOUNT REQUESTED:
We receive numerous requests for grants each year. Please explain how you think your
participation in the program would provide a distinct and positive addition to the class.
(Please limit your response to 150 words.)
TYPE
HERE:
I assure the accuracy of all information given to determine need. Furthermore, as a grant
applicant for
C-Change, I agree to devote the time and energy necessary to make it a successful
experience if I am selected.
CANDIDATES SIGNATURE:
DATE: