Membership Grant Application

Personal Information

First Name*

Preferred Name

Middle Name

Last Name*

Email*

Pronouns*

Birthdate*

Phone - Work*

Set phone - work type (HIDDEN)

Phone - Mobile*

Set phone - mobile type (HIDDEN)

Employment Information

Current Organization/Employer Name *
(Please choose from the autosuggest options - don't see yours? Email membership@gpacac.net)

Employer Key (HIDDEN)

You have not chosen an employer from the dropdown. Please do so before submitting the form!

Current Title*

When did you start your current position?*

Grant Application Questions

Has your school previously been a GPACAC member?*

When was the last time your school joined?*

Have you previously been an individual member of GPACAC?

When was the last time you were an individual member of GPACAC?*

Are you applying for individual membership ($25) or institutional membership $50 for all members of your team to join)?

How many team members are on your current staff who would benefit from GPACAC membership?*

How did you hear about the GPACAC secondary school grant application?*

Which member benefits are you most interested in? Check all that apply:*

Virtual Professional Development (1 hour sessions, topic centered)

Resources to help me perform my job

College Share event (virtual)

In-person professional development/networking events

Student scholarships

Networking/Connections

Volunteering on a GPACAC Committee

Annual Conference

Acknowledgement

I acknowledge that my school does not have funding to pay for a GPACAC membership.