SCHOLARSHIP REQUEST FORM

SCHOLARSHIP REQUEST FORM
Each Scholarship consist of 1/2 of Registration Cost (Dorm Rm. with meals) Registration "WITH" Scholarship: $21.00 for 1 Dorm Room with all 3 meals Registration without Scholarship: $42.00 for 1 Dorm Room with all 3 meals Separate Dorms for Men and Women Request separate Scholarship for each person NO Scholarships for White House Registration
Number of Scholarships Requested for a Man: *
Number of Scholarships requested for a Woman: *
Name of each Man to receive a Scholarship:
Name of each Woman to receive a Scholarship:
Name of Person making this request: *
Phone Number: *
Mailing Address: *
City, State, Zip Code *
Email: *

* = Input is required