Description about who the scholarship is awarded to. When are the finalist or winners announced. What do they receive? "*" indicates required fields Applicant InformationDepartment Name*Applicant Full Name* First Middle Initial Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone*Are you a current ULEAP member?* Yes No Do you need help with registration cost?* Yes No If Yes, what dollar amount?Do you need assistance with per diem and/or other expenses* Yes No If Yes, please explain:Are you willing to share a hotel room?* Yes No If Yes, please explain:ClassesWhat classes have you attended in 2022-2023, provided by ULEAP and otherwise?*What classes are you interested in and how will you share with others in your agency?*I agree…* I certify that my answers are true and complete to the best of my knowledge. Δ
