
Name:
Address:
City:
State:
Zipcode:
Work Phone:
Home Phone:
Fax:
Email:
Are you a current member of WCCAA?
Your signature:
Date:
What is the amount of your request?
ID # (for office use only)
ID # (for office use only)
Sandra Matter
GEHL-Kids Dept
8200 West Tower Avenue
Milwaukee, WI 53223
sandra.matter@ge.com
Phone: 414.362.2587
1. (10 pts.) Are you currently employed or otherwise actively involved in the field of child care and education? If Yes, in what capacity?
2. (15 pts.) Please provide a brief autobiographical sketch of yourself professionally, including areas in which your work has involved children and/or families.
3. (20 pts.) Describe the purpose for which you are requesting funds. If possible, attach a copy of a brochure or catalogue description of the course or workshop, if applicable.
4. (20 pts.) Explain how this scholarship would benefit you as a professional.
5. (25 pts.) It is the expectation of WCCAA that recipients will "give back" in some way. Suggestions include presenting a training to a local group, presenting a workshop at the state WCCAA conference or implementing a new program for parents or staff at a center. Explain how you would "give something back" as a result of this opportunity.