Elevate 2019 Scholarship Application

This offer is limited to 2 people per company. LMA/LMC board members are not eligible.

1. Name of person nominating *This question is required.

2. Title of person nominating *This question is required.

3. Company of person nominating *This question is required.

4. Email Address of person nominating *This question is required. This question requires a valid email address.

5. Scholarship applicant’s name *This question is required.

6. Scholarship applicant’s title *This question is required.

7. Scholarship applicant’s company *This question is required.

8. Scholarship applicant’s email address *This question is required. This question requires a valid email address.

9. What qualifies you for a diversity scholarship? *This question is required.

Race
Ethnicity
Gender
Work for a small media company
Disability
Other - Write In (Required) Please enter an 'other' value for this selection. * This question is required.

10. Please acknowledge that this candidate will be able to attend the full conference (starting at 10 AM on Tuesday, 9/17 and ending at 11:30 AM on Thursday, 9/19). *This question is required.