NPS Professional Development Application Form Non Point Source Professional Development Scholarship Form Name* First Last Organization*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Event Name*Event Description*Training Event Date* Have you received professional development scholarships from MWCC in the past?*YesNoAre you or your organization a member of the MWCC Partnership Program?*YesNoIs this training directly relevant to the implementation of your watershed restoration plan?*Yes, but my organization did not author our Watershed Restoration PlanYes and my organization was the author of our Watershed Restoration PlanNo, this training is not directly relevant to our Watershed Restoration PlanOur home watershed does not have a DEQ approved Watershed Restoration PlanExpensesLodging:Travel:Number of Miles to TravelMileage Reimbursement Total:(Number of Miles to Travel) * ($.54)Registration Cost:Other Costs:Please describe your 'other' expensesTotal Cost:Amount covered by individual or organization:Total Required:Please describe your unique need for assistance:*Please describe your effort to minimize costs (scholarships awarded, other efforts to cover costs, carpool, room share, etc.):*If awarded professional development assistance, Applicant must submit to MWCC an invoice for the amount of funds awarded and a summary of the training attended. The summary will include the specific impact the training had on the capacity of the organization. Summary will be submitted to MWCC prior to the next quarterly reporting deadline occurring immediately after funds are awarded. (Deadlines: January 1, April 1, July 1, and October 1).* I agree to provide MWCC will a brief report (300 words) within 30 days of the training that describes what I learned how I was able to apply the training to my work. Applicant Signature:*PhoneThis field is for validation purposes and should be left unchanged.