application for connecticut chapter scholarship  · web viewwho is currently enrolled in a massage...

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Dianne Polseno Memorial 2018 Connecticut Conference Scholarship Scholarship General Information Purpose: To promote massage therapy continuing education. Award: Full registration cost to attend the 2018 Connecticut Conference at the early registration rate. (Hotel accommodations are booked separately and are not covered by the scholarship.) Rules of Entry: Applicant must meet one of the following criteria: o Be a Student Member who is currently enrolled in a massage therapy program at an accredited school and is in good standing (must submit proof of status along with application). o Be a Professional Graduate member of the AMTA-CT Chapter. o Be a Professional member of the AMTA-CT Chapter for less than one year. Applicant cannot have been a recipient of the scholarship within the last two years. Applicant must complete all information and submit completed application to Rocky Perez, AMTA-CT Chapter Volunteer Management Chair. Winner will be announced at the January 2018 Chapter meeting. Applicant must be present to win. Winner must register for the Conference by the deadline for early registration. (You will have time to register after the selection process). Winner MUST submit a written article for the AMTA-CT Chapter newsletter following the Conference describing their conference experience. Article is to be sent to the Volunteer Management Chair by May 7, 2018.

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Page 1: Application for Connecticut Chapter Scholarship  · Web viewwho is currently enrolled in a massage therapy program at an accredited s. chool and is in good standing (m. ust submit

Dianne Polseno Memorial2018 Connecticut Conference Scholarship

Scholarship General Information

Purpose: To promote massage therapy continuing education.

Award: Full registration cost to attend the 2018 Connecticut Conference at the early registration rate. (Hotel accommodations are booked separately and are not covered by the scholarship.)

Rules of Entry:

Applicant must meet one of the following criteria:

o Be a Student Member who is currently enrolled in a massage therapy program at an accredited school and is in good standing (must submit proof of status along with application).

o Be a Professional Graduate member of the AMTA-CT Chapter.

o Be a Professional member of the AMTA-CT Chapter for less than one year.

Applicant cannot have been a recipient of the scholarship within the last two years.

Applicant must complete all information and submit completed application to Rocky Perez, AMTA-CT Chapter Volunteer Management Chair.

Winner will be announced at the January 2018 Chapter meeting. Applicant must be present to win.

Winner must register for the Conference by the deadline for early registration. (You will have time to register after the selection process).

Winner MUST submit a written article for the AMTA-CT Chapter newsletter following the Conference describing their conference experience. Article is to be sent to the Volunteer Management Chair by May 7, 2018.

Applications must be emailed to [email protected] by December 31, 2017. An email confirmation will be sent to you when we have received your application.

Please note:Applications must be completed in Microsoft Word (.doc) or compatible formats only.

No .pdf files will be accepted.

Page 2: Application for Connecticut Chapter Scholarship  · Web viewwho is currently enrolled in a massage therapy program at an accredited s. chool and is in good standing (m. ust submit

Dianne Polseno Memorial2018 Connecticut Conference Scholarship

Official Application for the Dianne Polseno Memorial ScholarshipPlease type or print legibly. All information must be complete and all questions must be answered.

Incomplete applications will be disqualified.

Applicant InformationName ____________________________________Address______________________________________City __________________________________________ ST ________ Zip ______________________ Phone ___________________ home cell work Phone _________________ home cell workEmail __________________________________________________________________________________Check one: Student Member Professional Graduate Member Professional Member

AMTA Membership #____________________ Member Since (mo/yr):___________

School Information (if applicable)

Name of School _________________________________________________________________________Graduated? Yes No If yes, date of graduation? _______________ If no, anticipated date of graduation? ____________

Current Status/GPA ____________ School Contact Name _____________________________ Phone: ______________________

By creating a separate document or using a separate sheet of paper, please answer the following questions in their entirety.

1. Please tell the Scholarship Committee why you are applying for this scholarship? Be sure to include an explanation of financial need and any other special circumstances or considerations.

2. Describe any volunteer and/or community service activities you have been involved in that are specific to massage therapy, the AMTA or the AMTA-CT Chapter. List events, projects and/or committees on which you serve or have served, positions held, dates, etc.

3. Describe any other volunteer or community service (not related to massage) you have been involved in at your school, local community or elsewhere in Connecticut. List events, dates, etc.

4. Have you ever been nominated for or received a Chapter Award? If so, please describe.

5. Did you attend any Chapter Meetings in 2017? (check as appropriate)

January April July October

6. What else would you like the Scholarship Committee to know about you or have us consider when reviewing your application?

Thank you for your interest in the AMTA-CT Chapter Dianne Polseno Memorial Scholarship!Applications must be emailed by December 31, 2017.

Applications must be completed in Microsoft Word or compatible formats only – no .pdf files will be accepted.

Please send your completed application by email to Rocky Perez at [email protected]. An email confirmation will be sent to you when we have received your application.