Submit An Application Worksheet

1. Name of the Memorial/Scholarship Fund for which you are applying:
   
   
2. Applicant's Name:
   
   
   
3. Applicant's Phone:
   
   
4. Applicant's Email:
   
   
5. Applicant's Address:
   
   
6. Applicant's City:
   
   
7. Applicant's State:
   
   
8. Applicant's Zip:
   
   
9. How will the applicant use the funding?
   
   
10. How do the goals and interests of the applicant mesh with the goals and interest of the person being memorialized?
    
    

1. For 2011, two awards of $250 each will be awarded on November 30, 2011.  Applications must be received by September 30, 2011.  The two best qualified will be chosen.

11. Other Questions or Comments?