City: State: Zip:

or

Country:

Telephone: Email:

Highest level of education completed to date:

Ethnicity:

Gender:

Are you a parent filling this out for your child?

Have you applied for other scholarship assistance?

If yes, with whom?

Have you received other funding for this same request?

If yes, how much?

Is this a one time request?

If no, will this be an annual request?

• Please submit a one page letter with all 3 topics: (1.) Intrroduce yourself, you goals and your interests and (2.) The benefit you will gain by attending this class/event or activity; and (3.) The benefit it will be for the family/neighbors/community/island/states and or world.

*Along with your letter of introduction, please submit 2 letters of recommendation/support