CUYAHOGA AMATEUR RADIO SOCIETY SCHOLARSHIP APPLICATION FORM |
Please Print or type |
INFORMATION ABOUT THE APPLICANT
Name of Applicant__________________________________________________________________________________
C.A.R.S. Member? ___ Yes____No If Yes, What is your call sign?_______________Attach a copy of your license
Address__________________________________________________________________________________________
STATE____________ ZIP________________ DATE OF BIRTH____________/_____________/__________________
PHONE __________________________ (home or cell) EMAIL ____________________@_______________________
WHAT SCHOOL ARE YOU GRADUATING_____________________________________________________________
DATE OF GRADUATION_______/_________/_____________ G.P.A._______________CLASS RANK_________
NAME OF COLLEGE, TRADE / TECHNICAL SCHOOL YOU PLAN TO ATTEND , WHEN
________________________________________________________________________ DATE_____/_____/________
Parent(s) or Guardian’s Name__________________________________________________________________________
Parent or Guardian Signature___________________________________________________________________________
INFORMATION ABOUT THE SPONSORING C.A.R.S MEMBER
MEMBER NAME_____________________________________________________ CALLSIGN____________________
AFFILIATION WITH APPLICANT_____________________________________________________________________
ADDRESS________________________________________________________________________________________
CITY_______________________________________STATE__________________________ZIP___________________
PHONE_____________________SPONSOR SIGNATURE _________________________________________________
PLEASE ATTACH AT LEAST A 150 WORD ESSAY TELLING ABOUT YOUR GOALS,
ACTIVITIES AND WHY YOU WOULD LIKE TO RECEIVE THIS $500 SCHOLARSHIP
I, ________________________________________, ATTEST ALL INFORMATION PROVIDED IS CORRECT AND TRUTHFUL.
APPLICANT SIGNATURE______________________________________________________DATE_____/_____/_____
CSC OFFICIAL USE ONLY |
NOTE: Applicants must submit this application to the scholarship committee NO later than May 30
DATE APPLICATION RECEIVED __________________/___________/__________ Membership status or Affiliation verified Y N APPLICATION APPROVED/DENIED _________________________________ POINT TOTAL__________________
Signed By: _______________________________________ _____________________________________
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Return this form to Bob Check, W8GC, 7395 Brecksville Rd., Independence, OH 44131 w8gc@2cars.org