NALS OF WASHINGTON

PP/PLS/ALS Grant Program Application

Please complete the entire Application. Incomplete Applications will not be considered.

1. 

Name:

 

2.

 Mailing Address:

 

 
3. Work Telephone:

 

 Home Telephone:

 

4.

 Chapter:

 

5.

 Will you use Grant funds to apply toward:

 

 ALS Exam

 

 PLS Exam

 

 Textbooks/Resource Manuals

 

 Cram Event

 

 NEI

 

 Other
__________________ PP Exam
Explain

 
6. Brief summary of why you should be considered for either Grant:

 

 

 

I agree to abide by the guidelines and criteria of the NALS of Washington PP/PLS/ALS Grant Program.
Signature

  

 Date:

 

APPLICATION MUST BE POSTMARKED BY APRIL 1, 2008, AND MAILED TO:

 Marina Anna Baker, Certified PLS
1201 Third Avenue - Suite 4800
Seattle, WA98101
mabaker@perkinscoie.com

Proof of Attendance

Please complete this form, have the PP, PLS or ALS Exam Administrator sign, and return it to the NALS of Washington Certification Director as soon as practicable.

 Sat for the entire PP, PLS ALS Exam or for Parts on ____________________, _________.

Exam Administrator:

 

 Date:

 

Updated:  8/5/2007