Scholarship Application Please complete the questions below so we can determine how much scholarship $$ you qualify for. NB: eligibility is not based only on your gross revenues - so be as accurate as possible with you rrevenue estimates. YOUR NAME* YOUR EMAIL* HOW MANY EMPLOYEES WORK IN YOUR BUSINESS 1 - 2021 - 5051 - 100100- 300300 - 500500+ WHAT STATE IS YOUR BUSINESS IN DO YOU HAVE A FULLY DOCUMENTED COMPLIANT DIVERSITY & INCLUSION PLAN YesNoDon't know IS YOUR BUSINESS A MINORITY OR WOMAN OWNED BUSINESS YESNO WHAT IS THE APPROXIMATE RATIO OF WHITES/CAUCASIANS Vs MINORITIES IN YOUR ORGANIZATION 90%+ White70% White vs 30% Minority50 / 50 White / Minority30% White v 70% MinorityLess than 10% White CAN YOUR ORGANIZATION AFFORD TO INVEST $499 (1 time/lifetime fee) FOR YOUR REGISTRATION FEE IF THE SCHOLARSHIP COVERS SOME/ALL OF THE REMAINING $11,709 FOR THE ENROLLMENT FEE YESNO WHAT IS YOUR TITLE / AREA OF RESPONSIBILITY WITH YOUR COMPANY? ARE YOU 1 OF THE PRIMARY DECISION MAKERS IN YOUR BUSINESS FOR DIVERSITY & INCLUSION PROGRAMS AT YOUR COMPANY YESNO APPROXIMATELY HOW MANY C LEVEL EXECS, MANAGERS, SUPERVISORS DOES YOUR COMPANY EMPLOY ARE YOU COMMITTED TO IMPROVING DIVERSTY & INCLUSION FOR YOUR ORGANIZATION WITHOUT DISPLACING YOUR CURRENT NON-MINORITY STAFF? YESNO WHAT WERE YOUR GROSS REVENUES OVER THE LAST 12 MONTHS Less than $500,000$500,000 to $1 million$ 1 million to $5 million$5 million to $10 million$10 million +$ 100 Million plus does not qualify PHONE # BEST DATE & TIME TO CALL YOU (include time zone)