PMP® Exam Prep Scholarship Program

Applicant Information
All Fields are Required

First Name:
Last Name:
Address 1:
Address 2:
City:
State:
Zip Code:
Home Phone:
Mobile Phone:
Email Address:

Please Describe Your Past Project Management Work History:
(Please do not paste your resume here)

Prior Employment Information
All Fields are Required

Prior Employer:
Address 1:
Address 2:
City:
State:
Zip Code:
Contact Name:
Contact Phone:
Date Unemployed:		(xx/xx/xx)

Reason for Unemployment:

Company-Wide Layoff
Job/Project Elimination
Resigned
Terminated for Cause
Job/Project Completion

*Describe Employment Circumstances (or attach documentation of layoff/downsizing or project elimination)

Describe:

or Attach:

Project Management Background
All Fields are Required

Years of PM Experience:

1-5
6-10
11-15
16-20
21 or more

Are you a member of PMI?:

Yes
No

If Yes, List PMI® Chapter:

Number of PM Classes Taken:

PM Class Names:

Previous PMP® Exam Courses?:

Yes
No

General Information
Please check all that apply:

I have at least 5 years of full-time experience in the discipline of Project Management.
I am currently unemployed due to a layoff, downsizing or project/department elimination.
I have been unemployed without a full paycheck or severance package for at least 90 consecutive days.
I perform no more than 15 hours per week of contract consulting.
I am a US Resident

Demonstrate Candidacy
Please use the text box below

In 75 words or less, explain why you feel you are a good candidate for this scholarship.

PMP® Exam Prep Scholarship Program

For Unemployed Project Managers