Scholarship Form

I hereby make application for grants-in-aid from the Virginia Municipal Clerks Association for the IIMC Institute/Academy for the year 2011.
Applications must be in by the July 1st deadline.

Membership in IIMC is mandatory for certification.

Are you a member in good standing of: *

Virginia Municipal Clerks Association (VMCA)? International Institute of Municipal Clerks (IIMC)? Both

Number of years you have served as a Municipal Clerk, Deputy Clerk, or equivalent *

Have you received scholarships to VMCA or IIMC functions in the past? *

If your answer is “yes”, please attach a list of the type of scholarships, years in which they were received, whether or not the scholarships were used by you, and the source of the scholarships. *

Explain briefly your reason for wishing to attend the Institute or Academy and why you want to become a Certified Municipal Clerk or to receive your Academy designation. *

Have you completed any of the phases of the Institute or Academy programs? *

Yes No

Have you applied to your local government for funds to attend the VMCA Annual Conference, Institute and/or Academy? *

Yes No

If so, what is the amount your locality has agreed to provide? *

Have you applied to your government for funds for other education, conferences, meetings, etc.? *

Yes No

If you are awarded a partial scholarship, will your employer pay the balance needed? *

Yes No

How do you intend to fund future VMCA or IIMC Annual Conferences, Institutes or Academies? *

Please send to the attention of the Scholarship Committee Chair written evidence from your Mayor, Manager, Administrator, Council/Commission or Board that, in the event the grant is awarded, you will be given time to attend the Institute/Academy.
The scholarship is non-transferable.

I DO HEREBY ATTEST THAT THE INFORMATION SUBMITTED IN AND WITH THIS APPLICATION IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. *

VMCA Scholarship Form