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SEAN Scholarship Application

Association Name
Contact Person (First, Last Name)
Title
Phone
Email

First Scholarship Recipient (To be paid for by State Executive Association)

Name
Chamber
Title
Address
Phone
Email

State Executive Association Attendee (To be paid for by ACCE)

Name
Chamber
Title
Address
Phone
Email

Payment Information

Submit your form to ACCE no later than May 16, 2014

Grand Total $
Payment Method

Checklist

 Complete State Executive Association Scholarship Recipients Form
 Make a credit card payment for $650 (see above) OR include a check made payable to ACCE for $650. This will cover the cost of the one scholarship paid for by your state association. Mail the completed form and check payment no later than April 18, 2014 to: ACCE-SEAN Scholarship 2014, PO Box 79245, Baltimore, MD 21279-0245. Please contact Trayvia Watson @ twatson@acce.org for any questions.
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