JCCI & JCCI Forward Member Scholarship Application JCC Interest
JCCI
JCCI Forward
JCCI Studies
JCCI Indicators
Personal Information *First:
*Last:
Nickname:
Birth date:
Marital Status:
Single
Married
Widowed
Work
Home
Divorced
Spouse Name: *I prefer to be contacted at: *Business Information *Company Name: Address: City
State
Phone:
Cell:
Email Address:
Web Site:
Assistant Name:
Email:
Zip
Home Information Address: City
State
Phone:
Cell:
Zip
Email Address: Scholarship Acceptance Information A Member Scholarship is a limited one-year membership, designed to introduce community members to JCCI’s process and programs. Recipients receive Friend member benefits and, in return, are expected to participate in a minimum of 4 hours of programs and or trainings during the scholarship year. By completing this application I accept the terms as stated above. If I do not meet the minimum programming/training obligation, I will be asked to reimburse JCCI for the one-year Friend Level membership fee.
Applicant Signature
Date