Open to: Members of NCAE4-HA for the purpose of professional development to enhance job and related skills (seminars, workshops, formal course work, study tours, interstate agent exchange, Executive Development Institute, etc.). Amount not to exceed $250, (pre-tax or reimbursable expenses).
Name:
Address:_________________________________________________________
Telephone Numbers: ________________Home ___________________Work
Describe your plan for utilization of this professional development scholarship
(i.e. seminars, workshops, formal course work, other
opportunities).
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
Have you received professional development scholarships through NCAE4-HA before? Is so, when?
_________________________________________________________________
Will you receive additional financial support for this professional development opportunity?
_________________________________________________________________
Amount of Request:__________________________________________________
Additional Comments:________________________________________________
_________________________________________________________________
_________________________________________________________________
Are you in a degree program? ___________________________________
Signature of Applicant
Due
Present Members Employed with NCCES Should E-Mail Form to:
R. Dale Safrit
State Chair, NCAE4-HA Professional Development Committee
dale_safrit@ncsu.edu
Hard copies from retirees, life-time members, etc., can be mailed to:
R. Dale Safrit
State Chair, NCAE4-HA Professional Development Committee
State 4-H Office
NCSU Box 7606
Raleigh, NC 27695-7606
dale_safrit@ncsu.edu
FAX 919-515-7812