ITC Leadership Academy Scholarship Application

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Up to two awards will be made from the pool of applicants based upon the following criteria:
Applicants must be currently employed at an Oregon Community College during the ITC Leadership Academy, be affiliated with distance education, and engaged in leadership activities at their college.

One award per college per year.

Name *

Title *

Community College *

College Email *

College Phone # *

Application materials should reflect how the applicant might apply this experience to local, regional, state, or national leadership in Distance Learning.

The selection committee will evaluate applications based on applicant’s expressed plans to impact distance learning at their college or within other areas.

Explain what you would like to gain through participation with fellow academicians *

Applicants will also submit a letter of nomination from their supervisor.

Nomination letters can be emailed to Kimberlie Veysey, OCCDLA Administrative Support: Kimberlie.Veysey@umpqua.edu

Supervisor Name and Title *

Date *

I have reviewed my application and emailed the nomination letter to the address listed above. *

Yes

Required

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Chemeketa Community College. Report Abuse

Forms