SCHOLARSHIP APPLICATION FORM Partial and full scholarships are available for teenagers who need financial assistance to attend a Teen Wilderness Adventure. Awards are made on a rolling basis beginning February 1st each year. Scholarships are awarded based on financial need and the articulated desire to participate in a Teen Wilderness Adventure. Please call Colby Meehan if you have any questions. Complete and sign the form (use additional paper if necessary) and mail, fax, or e-mail to: Colby Meehan, Education Programs Coordinator Appalachian Mountain Club PO Box 298 Gorham, NH 03581

Fax: (603) 466-2720 Phone: (603) 466-8125 E-mail: [email protected]

______________________________________________________________________________ Name of Participant

Date

Age

______________________________________________________________________________ Name of Parent or Adult Supplying Financial Information

Relationship to Participant

______________________________________________________________________________ Name of Youth Organization (if applicable)

Name of Youth Worker Contact

Phone Number

______________________________________________________________________________ Street Address

______________________________________________________________________________ City

State

Zip

______________________________________________________________________________ Phone (Day)

(Evening)

E-mail

Choice #1_____________________________________________________________________ Date

Description

Code

Course Fee

Choice#2______________________________________________________________________ Date

Description

Code

Course Fee

Choice#3______________________________________________________________________ Date

Description

Code

Course Fee

Annual Household Income after taxes: __________________

12/2014

Children in Your Family Name Age School/College ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 1. Amount you/your family can contribute towards a Teen Wilderness Adventure: ___________ 2. Please explain your financial situation and why you feel scholarship funds are necessary to enable you to register for a Teen Wilderness Adventure. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 3. How do you hope to benefit from participating in a Teen Wilderness Adventure? (We recommend this question be answered by the teenage applicant. If parents do not wish to include their child in the application process, this question may be answered by the parent stating how he or she expects their child to benefit.) ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

_________________________________________ Signature of Parent/Adult (Required)

Date

_____________________________________ Signature of Teen Applicant (Optional)

Date

12/2014

scholarship application form - Appalachian Mountain Club

Please call Colby Meehan if you have any questions. Complete and sign the form ... Organization (if applicable). Name of Youth Worker Contact. Phone Number ...

104KB Sizes 2 Downloads 367 Views

Recommend Documents

scholarship application form - Appalachian Mountain Club
necessary) and mail, fax, or e-mail to: Colby Meehan, Education Programs Coordinator. Appalachian Mountain Club. Fax: (603) 466-2720. PO Box 298.

Scholarship Application Form
Jul 31, 2013 - diploma (including BTech) at an accredited Higher Education ... Computer Science and Data Processing ... Health Care and Health Sciences.

Scholarship Application Form
Jul 31, 2013 - a member or staff member of one of the participating Trade Unions. • a child ... in doing vacation work for a 2 week period during the end-of-academic-year break. ... Computer Science and Data Processing .... Degree/diploma:.

Vocational Scholarship Application - Rotary Club of Austin ...
Try one of the apps below to open or edit this item. Vocational Scholarship Application - Rotary Club of Austin Southwest S17.pdf. Vocational Scholarship ...

Scholarship Application Form 2017.pdf
purpose of selection and will not be shared with any other group or organization. Page 1 of 1. Scholarship Application Form 2017.pdf. Scholarship Application ...

Application form for UCM Scholarship - Maastricht University
All students seeking financial assistance from University College Maastricht must complete this form. ... Number of dependent children whose tuition will be paid ...

APPLICATION FORM FOR OBC PREMATRIC SCHOLARSHIP 2014 ...
APPLICATION FORM FOR OBC PREMATRIC SCHOLARSHIP 2014-15.pdf. APPLICATION FORM FOR OBC PREMATRIC SCHOLARSHIP 2014-15.pdf. Open.

Application form for the MDH scholarship
your choice of study program would affect your personal and ... Upon completion of my studies in Sweden, I intend to reside in Sweden or other. OECD- ...

Application form for UCM Scholarship - Maastricht University
Address (postal address). Zip code & City. Country. Telephone ... combined gross annual income. €. Number of dependent children whose tuition will be paid ...

Jakob Hohm Scholarship Application-Non Snowmobile Club (2).pdf ...
There was a problem previewing this document. Retrying... Download. Connect more apps... Try one of the apps below to open or edit this item. Jakob Hohm ...

scholarship application - Kiwanis Club of Vero-Treasure Coast
Scholarship Committee. Kiwanis Club of Vero. Beach P.O. Box 6381. Vero Beach, Fl 32961. APPLICATION FORM--PLEASE PRINT. Full Name: Home Address: Mailing address (if different than home address). Email address. Home Phone. Cell. Male: Female: High Sch

Sports Scholarship Application Form 2014-15.pdf
HOW TO APPLY FOR A CAVAN INSTITUTE SPORTS SCHOLARSHIP ... COUNTY: ______ __ GRADE (tick where appropriate): Minor __U-21 __ Junior __ ...

2018 Educational College Scholarship Application Form (1).pdf ...
Page 1 of 6. 1-2018. EDUCATIONAL COLLEGE SCHOLARSHIP APPLICATION FOR 2018. The Nancy Lieberman Charities is pleased to offer the Nancy Lieberman. Educational College Scholarship to deserving high school student-athletes who. excel in sports and acade

PCARI Scholarship Application Form AY 2017-2018.pdf
A.Y. 2017-2018. TYPE OF SCHOLARSHIP APPLIED FOR: I. PERSONAL INFORMATION. a. Last Name First Name Middle Name. b. Permanent address No. Street City/Municipality Province. c. Zip Code Region District Passport No. E-mail Address. d. Current Mailing Add

Ontario Graduate Scholarship Application Form - Faculty of Graduate ...
Canadian Institute of Health Research (CIHR) ... Technology (QEIIGSST) ... I have given complete and true information on this application form and in the required supporting ... Degree status: completed, in progress, incomplete Degree name.

PCARI Scholarship Application Form AY 2017-2018.pdf
Page 1 of 4. M.S. Local Ph.D. Local Postdoctoral Study Award. M.S. Overseas Ph.D. Overseas Master's Sandwich Program Doctoral Sandwich Program. SCHOLARSHIP APPLICATION FORM. A.Y. 2017-2018. TYPE OF SCHOLARSHIP APPLIED FOR: I. PERSONAL INFORMATION. a.

Ghana Scholarship Application Form 2018 - University of Lincoln
Any International Scholarship decisions made by the University of Lincoln are final. ... Applicants will be informed of a scholarship decision within 10 days of the ...

fe- sfao form af scholarship application - University of Ghana
District: Region. Telephone#:. UG Email: Telephone#:. Alternative Email: 12. .... I do hereby declare that to the best of my knowledge all my information given in ...

Captain's Club application form 2018 (16%2F05%2F18).pdf ...
meals and refreshments - so no more issues with damaged and lost cards. ○ purchase ... Title Mr Mrs Ms Miss Other............................ ... Download Permission.

Scholarship Application Form.pdf
______ Documents for education IRA's or higher education savings plans that you own. ______ Student Aid Report (SAR) if you applied for a Federal Student ...

Toowoomba Mountain Bike Club Brochure.pdf
Whoops! There was a problem loading this page. Retrying... Whoops! There was a problem loading this page. Retrying... Toowoomba Mountain Bike Club Brochure.pdf. Toowoomba Mountain Bike Club Brochure.pdf. Open. Extract. Open with. Sign In. Main menu.

Cheyenne Soccer Club Scholarship Form.pdf
CSC reserves the right to. ask for proof of income. You may mail the form to CSC PO BOX 2774 Cheyenne WY 82003 or email to. [email protected] If ...

pro pro purchase program - Tufts Mountain Club
$249.00 $145.75. 52145 M's Graphic Tech Fish Tee. $45.00 $26.25. 82100 M's Guidewater Pants. $79.00 $46.25. 82110 M's Guidewater Shorts. $69.00 $40.25.