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FLORIDA SCHOLARSHIP(s) APPLICATION

Universal for any/all Florida Chapter or District Scholarships

CI-101 EDUCATION FOUNDATION CHAPTER Scholarships CCIM INSTITUTE PUSH FOR THE PIN Scholarship

Form updated July, 2010

FLCCIM CHAPTER-DISTRICT All Course Scholarships BOB L.WARD, CCIM, Endowed Scholarship ROGER B BRODERICK, CCIM, Endowed Scholarship (West Coast District Only)

Date Submitted: __________ District: __________ FL CCIM Chapter member? ____ as of date: ___________ Required for all scholarships upon application. Institute member? ____ as of date: ___________ Required for all scholarships, except CI-101 Ed Foundation. Have you taken any CI Courses? Yes __ No ___ - Intro__ CI-101__ CI-102__ CI-103__ CI-104__ I am applying for the following scholarship(s): Please clearly mark one or all you are interested in:

(If you've not taken any courses or only taken the Intro course, please choose the CI-101 as it is mandatory before taking any other core courses)

CI-101 Ed Foundation CI Push for the Pin FL Chapter/District Bob L Ward, CCIM Roger B Broderick, CCIM

(CI-101 ___) ( CI-103 __ CI-104 __)

(CI-101 __ CI-102 __ CI-103 __ CI-104 __)

(

CI-102 ___ CI-103___CI-104___)

(CI-101 ___CI-102 ___ CI-103___CI-104___) West coast only

Individual District Scholarships: (Intro ___ CI-101____ CI-102____ CI-103 ___ CI-104_____)

Each District awards their own scholarships in varying amounts & at varying times. This form should be used for any and all Florida scholarships. Refer to your District website for information on specific scholarships being offered.

Applicant's Full Name: _________________________________________________ SS# _________________ Company: ________________________________________________________________________________ Work address: _____________________________________________________________________________ City/State/Zip__________________________________ Email: ______________________________________ Work phone number: __________________ Alt/Cell phone: ___________________ Fax _________________ Home address: _____________________________________ City/State/Zip____________________________ How many years have you been involved in the commercial real estate industry? ______ Do you plan to obtain the CCIM designation? Yes ___ No ___ Timetable? ____________________________ R.E. License #______________ Institute Candidate ID#____________________ NERDs#_________________ Other Designations or Memberships ____________________________________________________________

Florida CCIM Chapter 341 N. Maitland Avenue, Suite 130 Maitland FL 32751

Page 2

Applicant's Name: _______________________

Please include the following with this application: 1. A current resume 2. Three professional references. Include their name, position, address, phone #, length of time you have known them and your relationship. Letters of recommendation can be submitted with your application 3. An electronic photo (*.jpeg) 4. Typed letter which includes answers to the following questions: Why do you want to become a CCIM? What are your contributing achievements to your company and/or industry? What are your career goals? Would you take the course, even if a scholarship were not available and why? Other criteria and mandates for statewide scholarships: 1. District committee appointment for award year (Appointed by District before final approval) 2. Have FL CCIM Chapter member serve as your mentor. (Selected by you or District before final approval) 3. Have current membership in FL CCIM Chapter (upon application) 4. Designated course may only be taken in the award is given, Year-2011. 5. Awards may not be used for a challenge course ­ classroom courses only. 6. Once selected, sign and return the Scholarship agreement form to the Chapter Scholarship chairman before applying for any course.

Please note: Applicants missing (or not complying) with any of the above information/criteria will be considered incomplete and will not be considered for awards.

By submitting this application, I understand/agree to the following: This Scholarship is only good for the year 2011 and no extensions will be granted This scholarship cannot be applied retroactively to a course taken in 2010 and therefore, upon notice of award, I will not be reimbursed for any course taken in 2010 This scholarship cannot be redeemed for its cash value I agree that in the event I am chosen to receive a scholarship, the CCIM Education Foundation and/or CCIM Institute and Chapters may use my name, likeness and/or profile in printed and electronic promotional materials. This scholarship applies to in-class instruction only (not applicable to challenge exams or online courses). Submitted by:_______________________________________________________________________ Applicant's signature Date

Florida CCIM Chapter 341 N. Maitland Avenue, Suite 130 Maitland FL 32751

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Applicant's Name: __________________________

Application deadline is September 30th

(We will accept them anytime throughout the year, but the deadline is Sept 30th. Some Districts may have other deadlines for their individual scholarship programs) Return the completed application to your District Scholarship Chairperson. No handwritten applications can be accepted. For additional Scholarship information or to obtain your District Chairperson contact information go to: http://FLCCIM.com

Then click on the links on the lower left hand side of the home page concerning Scholarships.

If you can't find what you are looking for and are having trouble contacting your District Chairperson, please feel free to contact:

Florida Chapter Chairman: Kurt R. Gies, PE, CCIM 2010 Florida Chapter Scholarship Chairman cell: 407-701- 9416 [email protected] or Vice Chairman: Ken Martin, CCIM 2010 Florida Chapter Scholarship Vice Chairman cell: 772-528-3412 [email protected]

____________________________________________________________________________________________________________

FOR CHAPTER USE ONLY

Approved by District President or Scholarship Chairperson: ______________________________________________________________________Date_____________ Accepted by FLCCIM Chapter Scholarship Chairman: ______________________________________________________________________Date_____________

TO BE COMPLETED BY CHAPTER SCHOLARSHIP LIAISON For CI-101: Packet Complete: _____ Yes _____ No

Reviewed by: ______________________________________________ Award: ___Yes ___No FLCCIM Chapter Scholarship Chairman Confirmation/Notes: ___________________________________________________________________________________ Florida CCIM Chapter 341 N. Maitland Avenue, Suite 130 Maitland FL 32751

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