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Impact 100 Jersey Coast Scholarship Application
Address Line 1
Address Line 2
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Date of Birth
Select all that apply
American Indian or Alaska Native
Black or African American
Native Hawaiian of Other Pacific Islander
Hispanic or Latino
NON Hispanic or Latino
Name of Employer (if relevant)
Interest in Impact 100 Jersey Coast
Have you ever been a member of an Impact 100 chapter?
Name of Chapter
Date(s) of Membership
How did you learn about Impact 100 Jersey Coast?
Why do you want to join our organization?
In which facet of our organization would you like to participate, and what skills and experience would you bring to Impact 100?
Are there any factors that would affect your ability to participate in our meetings and activities?
Requested Scholarship Amount
Partial: $550 contributed by member and $550 contributed by Impact Jersey Coast.
Full: $1,100 contributed by Impact Jersey Coast.
I have reviewed and agree to abide by all policies and expectations outlined as part of applying for scholarship funds.