2013 Scholarship & Homestay Application Form

Name: Organization:
Building Livable Communities with Transit

Role / Position: Address: City, State: Primary Phone: Email: Are you a student or will you be one in the fall (yes or no)? Zip: Other Phone:

Rail~Volution has a limited number of scholarships available based on need. Special consideration will be given to citizen activists and advocates working on transportation, community development, and land-use issues.

Application Deadline: 1. Request for Conference Support Friday, September 20, 2013 Please fill in the amount of assistance you are requesting. EMAIL: bbakkenta@psrc.org Registration Amount Requested:

MAIL:
Puget Sound Regional Council 1011 Western Avenue Suite 500 Seattle, WA 98104

2. Please provide information about your organizational or individual need for scholarship assistance:

PHONE INQUIRIES: Ben Bakkenta 206-971-3286

2a. How will you use the information gained at the conference to enhance citizen activism and to promote transit in your community:

3. Organizational Information (N/A if not affiliated with an organization): Describe your organization, including information about age, mission, goals and activities:

3a. Organization's annual budget (Select One): $0 - $499,999 $500,000 - $999,999 $1 million - $10 million $10 million - $100 million more than $100 million __________ __________ __________ __________ __________

3b. Amount of financial assistance your organization is able to provide toward your Rail~Volution registration:

4. Student Information (N/A if not a student): Please describe your major, degree of study, and your professional aspirations:

4a. Do you have an internship; are you volunteering with an organization? Please describe:

4b. Are you a member of a local, activist organization? Describe your involvement with the organization:

5. Homestay Information: We wish to provide an opportunity for out-of-town attendees to stay with local community members. This will increase the opportunity for attendees to network with area residents and also reduce costs. Please indicate below if you would like to be a homestay host: Matched Homestay Hosts will receive a free conference registration. ____ YES, I would like to provide housing for a conference attendee(s) October 20 October 23?

How many guests are you able/willing to host in your home? _____

Do you live within a half mile (walking distance) of public transit? ____ NO ____ YES o What is the most convenient transit service from your home to the Westin Seattle at 1900 5th Ave.? ____________________________________________________________ o Can you travel from home to downtown Seattle in less than 40 minutes? ____ NO ____ YES o Does the trip require more than one transfer? ____ NO ____ YES o Does the service continue well into the evening hours? ____ NO ____ YES Do you live in a bike-friendly area? Can you provide a loaner bike to your guest? Can you provide secure bike parking for your guest? ____ ____ Smokers welcome Private room available ____ ____ Non-smoking home Expect guest to share a room ____ ____ ____ NO NO NO ____ ____ ____ YES YES YES

____ No pets in home ____ Host has pets (please describe): ____________________________________________________________________________________ ____ Car parking space available ____ Limited street parking for car (if at all)

Please specify any other special considerations: