Name *

First Name

Last Name

Please select which FGLI Consortium events you have attended (check all that apply): *

Conference

Colloquium

Webinars

None - I haven't attended any FGLI Consortium events before

Please select your professional level: *

Graduate Student

New Professional

Mid-level Manager

Senior Leader/Manager

Other (write in below)

I acknowledge that my professional development funding has been either cut or eliminated this year. *

Yes

No

I understand that this scholarship covers the conference fee only, and does not cover expenses related to travel, hotel, etc. *

Yes

No