Avrohm Wisenberg Scholarships

2011 CIC/CISR Memorial Scholarships
Nomination/Application Form

If you would like to apply for or nominate someone for the Avrohm Wisenberg 2011 CIC/CISR Memorial Scholarships, please fill out the form below, completing all information as requested. Once done, click on the Submit button to send the application to TSLA. All applications must be submitted by 12:00 noon on September 06, 2011.

Scholarship Type 1. I am applying for the:  CIC Scholarship CISR Scholarship

Applicant's Information 2. Applicant's Name:  Nominated By (if applicable):  Agency:  Street Address:  City:    State:   Zip: Phone Number:    Fax Number: Email Address:

Applicant Experience / Consideration 3. Please write a brief description of work experience, commitment to professional advancement,     and reasons why the applicant should be considered for the scholarship:

Applicant Status 4. Has the applicant started the program to which he/she is applying for a scholarship?  Yes No

Comments / Questions 5. Additional Questions or Comments:

Please click on the "Submit Form" button to send your nomination / application.
One of our representatives will respond to your submission as soon as possible.