APPLY FOR A WEDLI'S DOROTHY TRIPP/ SALLY SLACKE SCHOLARSHIP AWARD

Directions:
Print out application and complete all questions.
Mail with any supporting documents to:

Roslyn Goldmacher, Esq.
President & CEO
Long Island Development Corp.
45 Seaman Avenue
Bethpage, NY 11714

Name of
Applicant: 

Home Phone:

Email:

Zip:

For Female Entrepreneur:

What percentage of business do you own?

How long in business:

Type of business:

Brief description of business:

For economic developer:
Describe your position in economic development:

For both: Describe how this scholarship will help you:

If existing business, 3 years financial statements or federal tax returns (profit & loss; balance sheet);
If start up, opening balance sheet and projected profit & loss 2 years;

For both: what was your personal gross income last year?_________ How much do you personally have in liquid assets (savings accounts, checking, cd's,money markets, stock accounts)?_________

Note: these scholarships are to help deserving entrepreneurs and economic developers who need assistance to accomplish their dreams.

Signature:_____________________________

Print Name:____________________________

Signed by applicant______ or nominator_____

Print out and mail completed application to:

WEDLI Scholarship Committee
Women Economic Developers of LI
Roslyn Goldmacher, Esq.
President & CEO
Long Island Development Corp.
45 Seaman Avenue
Bethpage, NY 11714

NOTE: APPLICATIONS NOT ACCOMPANIED BY THE APPROPRIATE ATTACHMENTS, NUMBERS II THROUGH IV ABOVE, WILL BE CONSIDERED INCOMPLETE AND WILL NOT BE CONSIDERED FOR AWARDS.

Deadline: May 1, 2005