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Home > Events & Programs > Dorothy B. Brothers Scholarship > Scholarship Program Application

2008 Dorothy B. Brothers Executive Scholarship Program Application

(Brought to you by Bank of America and its suppliers)

Contact Information Name (First, Middle Initial, Last):

Title:

Company:

Business Address:

City, State, Zip:

Telephone:

Fax:

Email:

WBENC Certification Number:

Company Information Business Description:

NAICS Code(s):

SIC Code(s):

Year business was started:

Have you ever attended an executive education management program? Yes No

Number of full-time employees:

Number of part-time employees:

Volume of sales ($) for the past three years

2005

2006

2007

(Note: While the acceptable range for scholarship eligibility is $500,000 to $50,000,000, businesses with revenues outside this range that believe they have a compelling reason to receive a scholarship are welcome to apply. Please outline your reason(s) in the essay portion of this application).

Percentage of your revenues that are public: %

Percentage of your revenues that are private: %

Which of these describes your ownership situation? Partnership Sole Proprietor C Corporation S Corporation Other

Percentage of the company you own: %

What percentage of your business is:

Local

Regional

National

International

How many contracts or business prospects does your company have pending?

Provide the estimated percentage growth of your company in the next five years. %

Who are your major customers? Please provide names, industries, and percentage of annual sales. Total years of business/management experience you have: Describe your current responsibilities. List your professional memberships, volunteer board memberships, and volunteer community activities. List honors, awards, or other recognition you (or your company) have received. Include granting organization name and year awarded.

Education

Institution	Major	Degree	Date

Attendance at other professional seminars/conferences

Topic	Location	Date

Essay

Your comments will assist our selection committee in evaluating your application. (Please use space on last page for essay. Limit to one page for essay.) Please define acronyms and abbreviations.

What would you like to accomplish for your business as a result of participating in an Executive Education program? We would like to know:

Your company’s greatest vulnerability/liability at the present time and how you believe an executive training program will assist you in overcoming/addressing this.

The specific business-related area that is the most challenging for you personally and how an executive training program will address this.

The specific “gap” that you believe an executive education program will fill in your business.

IMPORTANT

Business Plan: Please email a 2-5 page summary of your business plan to Elsie Gomes, egomes@wbenc.org. The plan should include the following:

(1) Executive Summary that includes a company overview;

(2) Products & Services;

(3) Market Analysis, Strategy & Implementation;

(4) Management Summary;

(5) Financial Plan (optional).

While the financial section is optional, we encourage you to include this information as it will provide information that is relevant to the decision-making process. All financial information will be kept strictly confidential. Selection committee members will be required to sign a Confidentiality Agreement.

Essay Response:

Other Information, Please indicate status. (Not required) African American Hispanic American Asian Indian Latin American Asian Pacific
Native American Caucasian
Other (please specify here):

Application Deadlines and Disclaimers Early application is strongly encouraged. The final deadline for applications is April 30, 2008.
All information submitted with the scholarship application becomes the property of WBENC. Any material misrepresentation of information in this document is grounds for denial of scholarship consideration.

Cost

The scholarship award covers up to $4,500 in executive education tuition only between July 2008 and May 2009. Other expenses such as airfare/travel will not be covered.

A feedback form will be provided if applicant is awarded the scholarship. By checking here applicant is agreeing to complete and return the feedback form to WBENC within a year of being awarded.

Applicant must check this box and list name below.

I , agree to be surveyed about my experience in order to provide feedback to WBENC

If you have any questions, please contact Elsie Gomes at 202-872-5515 x 8023.

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2008 Dorothy B. Brothers Executive Scholarship Program Application

(Brought to you by Bank of America and its suppliers)

IMPORTANT

Cost