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Impact 100 Jersey Coast Scholarship Application
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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?
Have you attended an Impact 100 Jersey Coast event? If yes, which one?
Why do you want to join our organization?
Why do you you need this scholarship in order to join?
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. (NOTE: If you are awarded this partial scholarship Impact must receive your portion of the Membership Donation by March 31st.)
Full: $1,100 contributed by Impact Jersey Coast.
Date of Birth
Name of Employer
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
I have reviewed and agree to abide by all policies and expectations outlined as part of applying for scholarship funds.