WISCONSIN ASSOCIATION OF ASSESSING OFFICERS

SCHOLARSHIP AND GRANT APPLICATION

*Name*			*Date*
*Title*
*Affiliation*
*Address*
*City*	*State*	*Zip*
*Phone*
*Fax #*
*Email Address*
*Are you presently working in the Assessment field?*
*In what capacity? Please circle: Full Time, Part Time, Student, Intern*
*How many years have you been a member of WAAO?*
*Please circle each are where you have participated, and list the year (s)*
WAAO Committee Member WAAO Committee Chairperson WAAO Officer or Director
Past Committee Member Past Committee Chairperson Past Officer or Director
*Which grant or scholarship are you applying for?*
*Have you applied for this grant or scholarship before? If so, when?*
*Have you received any grants or scholarships from WAAO before? If so, when?*
*Does your supervisor support your request and will they grant time off if needed?*
*Explain how this grant / scholarship will assist you in achieving your long range career goals.*


*Please provide the details of your request which you would like the the Awards Committee to consider when reviewing your application.*