SCHOLARSHIP APPLICATION
FORM
Applicant Names:_________________________
Address:________________________________
Phone Number:______________________________ Email:______________________
Program Name:_________________________________________________________
Location:_______________________________________________________________
Dates:_________________________________________________________________
_____ I
am applying for a scholarship to the above named UU activity. I understand that this application will be
approved based on the availability of funds.
_____ If I (or my child) do not attend the
activity, I understand I must' reimburse the scholarship fund for the amount
awarded.
_____ I understand that no volunteer hours
or other form of restitution are required to receive this scholarship, but that
I am strongly encouraged to
participate in UUCA fundraising activities so that scholarship funds will be
available for future applicants.
_____ I
have attached a copy of my registration form to this application.
Signature:__________________________________________ Date:
Turn in to the RE
Director or Denominational Affairs Committee Chair
For UUCA Use:
Date Received:__________________
Approved by:_________________
Check
Request Date::__________