Name___________________________________________________

Address_________________________________________________

Phone number: Home___________________ Work__________________

Statement of Purpose (50 words or less):

Dollar amount requested ($50 minimum-$500 maximum):

Background of individual or group submitting the request:

Impact of the proposal on the profession or community:

Detailed explanation of how the award will be used:

Additional paper may be used to answer any of the above.

Submit to: Rachel Mann, 302 N 15th Street,

Wilmington, NC 28401, or This e-mail address is being protected from spam bots, you need JavaScript enabled to view it , by August 1, 2008.

The board of directors will review applications and announce recipients at the Chapter Annual Meeting on August 17, 2008.