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Scholarship Application
2022 Summit on Racism - November 10, 2022
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Name
Your answer
Address
Your answer
Telephone
Your answer
Email Address
Your answer
Institutional affiliation, if any
Your answer
Please check any and all of the following that applies to you. I am:
a graduate student
an undergraduate student
a K-12 teacher or educator
a K-12 student
an academic
Other (see below)
Please explain your position
Your answer
Demographic Information - SHARE encourages diversity and requests this information so that we may provide scholarships to a range of people.
Under 18
18-24
24-30
30-39
40-62
Over 62
Gender
Your answer
Racial and ethnic identity.
Your answer
Have you ever attended a Summit on Racism?
Yes
No
Clear selection
If so, when?
Your answer
Please answer the following questions.
Explain your financial need.
Your answer
State the benefits to you, your community or group which will result from your attending the Summit on Racism Association. (Please respond as fully as possible; responses should be no more than 300 words.)
Your answer
You will be contacted if your application is approved or denied.
For more information, contact: Pat Davis at (269) 381-9775 or
share471a@gmail.com
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