A Circle of Ten, Inc.

- Network for Collaboration

Mission: To empower leaders and foster healthy collaborations to improve quality of life.
Vision: A Circle of Ten is a catalyst & neutral intermediary agency that builds capacity of
leaders and communities, multiplies services, and increases funding in Texas.
Phone (903) 541-0013
Fax (888) 214-5210

205 E. Commerce #205

Jacksonville, TX 75766

circleof10@circleof10.org
www.virtual-village.org

Scholarship Application
Date: __________
Workshop Dates you want to attend:

Part I_______

Part II_________

Name: ___________________________ Title: ______________________

What agency are you representing? _______________________________
Geographical areas served:______________________________________
Income level of populations you serve:____Low _____Middle____High
Services offered: ______________________________________________
____________________________________________________________
Where else do you volunteer? What role do you play? ________________
____________________________________________________________
What are your goals for attending this workshop?_____________________
____________________________________________________________
____________________________________________________________
Do you know the Current Budget of the agency you are representing?
Yes ____ No ____
Amount if known $____________
Scholarship amount requested $_____ Amount from other sources $_____
Signature_____________________________________

For C10 Use Only:

Approved__ Denied__ By__________ Source____________ $________
Comments:__________________________________________________________________________
____________________________________________________________________________________

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