GEORGIA ASSOCIATION OF PHYSICAL PLANT ADMINISTRATORS
Scholarship Application
Last Name: _______________________________ First
Name _______________________ MI: _______
Institution where employed:
_____________________________________________________________
Job Title:
_______________________________________________ S.S.N. ______ - ____ -
__________
Work Address:
________________________________________________________________________
_______________________________________________________________________
________________________________________________________________________
City: ____________________________ State:
______ Zip Code: _______________
Work Phone Number: ___________________________ FAX:
_________________________________
Email Address, if available:
______________________________________________________________
Original
Employment Date: _________ Number of months or years in Facilities field:
___________
Category
of educational and training experience you wish to attend:
_______ APPA Institute
for Facilities Management
_______ APPA Leadership
Academy
_______ Other, please define:
___________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Brief
description of why this training is relevant to your job.
_______________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
I
hereby certify that the above information is complete and correct. I state that it is my intention to remain
in the facilities field, and I am
applying for this scholarship to benefit my institutionand to enhance my
professional life. I promise to make
every effort to satisfactorily complete any and all coursework
associated with my scholarship.
Signature:
_____________________________________ Date: ________________________________
Supervisors recommendations and comments:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Supervisors
Name: ________________________________ Title: ________________________________
Supervisors
Signature: ______________________________ Date: _______________________________
MAIL APPLICATION TO:
Jodie Sweat
Kennesaw State University
Kennesaw, Ga 30144-5591
Wk 770-423-6224
Fax 770-423-6522