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CCL Diversity Scholarship Application
THIS APPLICATION IS CLOSED
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Full Name
Your answer
Phone Number
Your answer
Email
Your answer
Street, City, State, Zip Code
Your answer
Race/Ethnicity
African American/Black
Asian
Hispanic/Latino
Middle Eastern/North African
Native American
Pacific Islander
Other:
Clear selection
Political affiliation
Democrat
Republican
Libertarian
Green
Unaffiliated/Independent
Other:
Clear selection
Are you a student?
Yes
No
Clear selection
Will you be over 18 by the time of the conference?
Yes
No
Clear selection
CCL chapter (if applicable)
Your answer
What is your background or involvement in CCL?
Your answer
How are you engaged already on the issue of climate change?
Your answer
Why would you like to attend the June International Conference and Lobby Day?
Your answer
Are you applying for a $500 or $250 scholarship?
$500
$250
Clear selection
What are your estimated travel and lodging expenses?
Your answer
How do you anticipate using the conference/lobby day experience back home?
Your answer
We would like you to have the support* of a CCL leader in your area. Which Group Leader, State Coordinator, or Regional Coordinator is supporting you and your application? (If you need help connecting to a GL/SC/RC, email
adeline@citizensclimate.org
)
Your answer
support*
By support we mean approving your application and planning to follow up with you after the conference to talk with you about your next steps as a climate advocate.
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