RPL Scholarship

Judy Brackin RPL Scholarship Application Form

Applicant Name:

APCO Membership #:

Years of APCO Member:

Years as PA Chapter Member:

Applicant Agency:

Agency Address:

Agency Contact:

Agency Contact Email:

Agency Contact Phone #:

Attach the following documents:

1. A formal and prestigious letter serving as an acknowledgment of excellence within our industry.

2. Brief description of your RPL service project plan and how it will benefit our chapter and/or your agency.

3. List of two (2) professional references

Upload Files

By signing this form I agree if accepted for the Judy Brackin RPL Scholarship, I will complete the RPL program in its entirety. If I do not complete the RPL Program I will make arrangements to reimburse the PA APCO Chapter, the full tuition amount.

Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.