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Scholarship Application - New York State Municipal Clerks Institute 2023

  1. Please include position title and dates held. Separate each position with a comma

  2. Yes or No & Date

  3. Include dates attended.

  4. Yes or No with Date 

  5. Include dates attended

  6. List name of academy and dates attended. 

  7. Include location and dates attended

  8. Please include any prior education from NYSTCA, Association of Towns, County Town Clerks Association and other. 

  9. Please include dates of RMC and renewals. 

  10. List dues paid to organizations paid for by the Town and yourself. List the organization, the amount, and who it is paid by 

  11. Explain actual financial expenses for education for the past two (2) years: (List year and amount i.e. 2019/$75). Include details. You may upload a budget document using the file upload at the end of this form. Please indicate that you will be uploading a document by stating : "Uploaded Document".

  12. You may upload a budget document using the file upload at the end of this form. Please indicate if you will be uploading a document by stating : "Uploaded Document."


  13. You may upload a budget document using the file upload at the end of this form. Please indicate if you will be uploading a document by stating : "Uploaded Document".


  14. Have you previously applied?
  15. Yes or No. Include dates received if yes or no. 

  16. Please have the Supervisor submit a letter that includes the statement below on behalf of the Town Board indicating rather or not your Town will assume the balance of your costs for attendance at the New York Municipal Clerks Institute. I, _________________________________Supervisor of the Town of ____________________ on behalf of the __________________Town Board do hereby agree to assume all cost over and above the amount of the NYMCI Scholarship Grant related to attendance of the ________________ Town Clerk at the 2023 New York Municipal Clerks Institute. I also understand that membership in the NYSTCA is required to receive any scholarship. Or The Town of ________________ will not be paying the cost of attendance of the __________________ Town Clerk at the 2023 New York Municipal Clerks Institute. 

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  18. This field is not part of the form submission.