Nonprofit Scholarship Application

"The very essence of leadership is that you have to have a vision."
– Theodore Hesburgh

All fields are required. If a field is not applicable to you, please enter "n/a." Once you submit this application, you will not be able to change or view your application. If you would like to PRINT a copy for your records, please do so before clicking “Send.”

Eligibility requirements:

· Full-time professional Executive Director or direct report to Executive Director managing people and/or projects and programs
· Professional outside Board of Directors
· Full support from the organization
· Documentation that the organization is a 501(c)(3)
· Incorporation for at least five years
· Commitment to attending all sessions of the program

Series applying for:

About Your Organization

Executive Director:

Number of Employees:
(indicate part-time and full-time)

Board Members:
(names/companies represented)

Headquarters Location:

About You

First Name:

Last Name:

Preferred Name:

Title:

Company Name:

Business Address:

City:

State:

Zip:

Business Phone:

Cell Phone:

Web Address:

Operating Budget:

less than $2 million
more than $2 million

Are you a NAM Member:

Yes No

Business Fax:

Business Email:

Confirm Business E-Mail:

Home Address:

City:

State:

Zip Code:

Home Phone:

Home E-Mail:

Confirm Home E-Mail:

*All correspondence for the program will be sent by email. Please provide an alternate email.

About Your Participation

Please note: Attendance is required at all sessions, as each session builds upon the previous. Please ensure you are able to attend all program sessions before you apply.

Who is authorizing your participation in this program?

Name:

Title:

E-mail:

Session 1 will begin with a 2-hour program orientation for you and either your supervisor or company sponsor. This person should also attend Session 4 with you. Please indicate who that person will be:

Name:

Title:

Email:

Briefly explain why you want to participate in this series:

About Your Background

State your education history, including degrees, dates, honors (college, graduate school, professional education).

College	Degree	Dates From/To	Honors
		from: to:
		from: to:
		from: to:

Give a brief employment history in chronological order, starting with your present position.

Organization	Dates From/To	Title/Position
	from: to:
	from: to:
	from: to:

Please respond to the following questions (limit 200 words or less per question).

List any leadership or management development programs attended:

Give a brief description of your career objectives:

Have you ever attended an ICAN program?:

Yes No

List community, civic, business, professional and social organizations in which you are an active member:

Please select those items in which you have an interest:

Being a mentor
Having a mentor
Having a professional coach

About Your Current Position

Number of years in Supervisory Role (if applicable):

Annual Compensation:

What are your job accountabilities?

How long have you been in this position?

What are the current leadership and/or organizational challenges you face?

What is the outcome you are looking to achieve upon completion of the program?

How did you hear about the ICAN scholarship?

Are there any special accommodations that you require?

Do you have any dietary restrictions ICAN should know about?

Please supply is with the email of the person who recommended you:

I UNDERSTAND THAT ALL INFORMATION SUBMITTED WILL BE USED BY THE ICAN, INC. OFFICE AND THE SELECTION COMMITTEE ONLY. FACILITATORS PLEDGE ABSOLUTE CONFIDENTIALITY REGARDING INFORMATION CONTAINED IN ALL ASSESSMENTS. I UNDERSTAND THAT SUBMISSION OF THIS COMPLETED APPLICATION INDICATES THAT BOTH MY EMPLOYER AND I HAVE REVIEWED AND ACCEPT THE PROGRAM'S REQUIRED COMMITMENT OF TIME AND FINANCIAL RESOURCES.

I accept:

Yes

Please note: Once your application is received, you will receive an email confirmation from ICAN. IF YOU DO NOT RECEIVE AN EMAIL WITHIN 3 DAYS, please contact ICAN to confirm receipt of your application.

Once you submit this application, you will not be able to change or view your application. If you would like to PRINT a copy for your records, please do so before clicking “Send.”

For information about the application process, please click here.

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