Application for MArtap Training Scholarship

Agency:
Type of Agency:
Section 5311 (18) Recipient:
 RTA RTA Contractor
Section 5310 (16) Recipient:
 non-urbanized urbanized area
RTA Operating Company:
Private non-profits and human service agencies:
Private bus operator in non-urbanized area:
Council on Aging:
Exec. Director/
Administrator:
Address:
City, State, Zip:
Telephone:
Fax:
E-Mail:
Name of Attendee:
Attendee's Position:
Date of Submission:

Conference/Program Information

Name of Program:
Location:
Sponsor:
Program Dates:
Please provide justification for program attendance and scholarship request:

Scholarship Group

Rural Large Rural Small Urban Urban COA/Non-Profit

Budget Estimate

Registration Fee or Tuition: $
Air Fare: $
Train Fare: $
Boat Fare: $
Taxi/Bus Fare: $
Auto (# miles X $0.445 per mile): $
Auto Tolls: $
Parking: $
Lodging: $
Meals (# days at no more than $40 per day): $
Total Estimated Expenses: $
Agency Contribution if applicable: $
Amount of Scholarship Request: $



Be sure to complete the estimated expense. Once approved, MArtap will return this form to you via email. After your attendance, use the form when you complete the Actual Expenses. This will save you the step of re-entering the previously supplied information. For more information click here for MArtap Scholarships. Questions? Call Carol Tally at 877-MArtap1 (627-8271) or info@martap.org.