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Thelma Raisor Scholarship Award Application
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Name
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Telephone Number (Daytime)
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Telephone Number (Evening)
Fax Number
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E-mail Address
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Employer Name
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Title
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Years With Employer
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Years In National APA
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Years In Local APA Chapter
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Activity/Event the scholarship funds are being requested for
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Briefly describe why the scholarship funds are being requested
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Tell us about yourself
i.e., participation in the APA, offices held, seminars/conferences attended, community service activities, career accomplishments and career goals
Feel Free To Attach Any Additional Information