Impact100 Southern Connecticut

2025 Scholarship Application Form

Scholarship Application

Through the generosity of our Member PLUS Champions, Impact100 Southern Connecticut is pleased to have several scholarships available to assist with the cost of membership dues for prospective members. If selected, Impact100 Southern Connecticut will match your $500 donation with $500 (to fund our grant pool with a full $1,000) and give you full membership voting privileges for the scholarship year awarded.

Scholarships recipients are expected to be active participants in Impact100 and serve on a focus area committee, operational committee or otherwise contribute their time and talents to the success and mission of our organization. Scholarship applications will be reviewed in order received by our Executive Committee and notifications will be made no later than March 15, 2025. If selected, scholarship recipients must complete the Membership Application form and make their $500 financial contribution by March 31, 2025.

Note: Impact100 Southern Connecticut will not disclose the names of members granted scholarships outside of the Board of Directors.

First Name *

Last Name *

Email *

Address *

Address 2

City *

State *

Zip *

Preferred phone number: *

Date of Birth (mm/dd/yyyy) *

We are excited to hear from you! Tell us a little about yourself. *

Why do you want to join Impact100 Southern Connecticut?

Please tell us how you would like to be involved in Impact100 Southern Connecticut? Please include any personal interests, expertise, experiences, perspectives or other qualities that you feel would be an asset to the organization.

How did you hear about Impact100 Southern Connecticut? If via a member, please include member name.

Acknowledgement: I understand that if I am selected for a scholarship, I will be required to make a $500 donation to Impact100 Southern Connecticut to become a member with full voting privileges. I further understand and agree that I will be an active member and engage and participate in Impact100 Southern Connecticut activities to help fulfill our mission to fund transformational grants to local nonprofits to change lives for the better in the Southern Connecticut community. Please indicate your understanding by typing your name and the date below. *