2013 WEA ProTeach® Jump Start Needs-Based Scholarship Application Survey

2013 WEA ProTeach® Jump Start Needs-Based Scholarship Application

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	WEA strives to provide equal access for all members to attend a ProTeach® Jump Start. Lack of personal financial resources should not be a barrier for participation. Please complete this survey if you are a WEA member seeking additional resources to further offset your Jump Start costs. This application should take approximately 5 minutes to complete. Your responses will be kept confidential and will not be used for any purpose other than to determine eligibility for financial assistance for the 2013 WEA ProTeach® Jump Start seminars. When registering for Jump Start please select the "Pay by Check" option and wait for our notification of the amount you will need to pay.

1. Please tell us your name:

Please tell us your name: First Name
Last Name


	* 2. What is your preferred email address? What is your preferred email address?


	* 3. If you have a secondary email address please enter it here: If you have a secondary email address please enter it here:

4. Which seminar will you be attending?

Which seminar will you be attending? ProTeach® Candidate - Spokane, June 24-27, 2013

ProTeach® Candidate - Marysville, July 29 - August 1, 2013


	* 5. Please give us the name of your WEA local association: Please give us the name of your WEA local association:

6. Have you sought assistance for Jump Start from other sources (e.g., your school, district, local association, etc.)?

Have you sought assistance for Jump Start from other sources (e.g., your school, district, local association, etc.)? Yes


	* 7. If you answered 'Yes' please describe your efforts: If you answered 'Yes' please describe your efforts:


	* 8. How much do you project that you will pay out of your personal funds for total certification expenses, excluding any costs associated with the Jump Start? How much do you project that you will pay out of your personal funds for total certification expenses, excluding any costs associated with the Jump Start?


	* 9. How much do you project that you will pay out of your personal funds to attend Jump Start (e.g., travel, lodging, etc)? How much do you project that you will pay out of your personal funds to attend Jump Start (e.g., travel, lodging, etc)?


	* 10. Please briefly describe your need for additional financial resources to participate in the Jump Start seminar: Please briefly describe your need for additional financial resources to participate in the Jump Start seminar:


	* 11. Of the total Jump Start registration fee, how much would you be comfortably able to contribute yourself? (Please Note: it is only under very unique circumstances that we will award a scholarship covering the full registration amount; most scholarships awarded are partial grants.) Of the total Jump Start registration fee, how much would you be comfortably able to contribute yourself? (Please Note: it is only under very unique circumstances that we will award a scholarship covering the full registration amount; most scholarships awarded are partial grants.)