VVA Chapter 776 - Scholarship Application
(Characters limited... please use separate sheet if needed!)
(Characters limited... please use separate sheet if needed!)
(Characters limited... please use separate sheet if needed!)
Street City State Zip
Name:
Father:
Name of relative and their relationship/affiliation with VVA Chapter 776:
Address:
Name of High School or College Attended:
Cell Phone:
Home Phone:
Date Entered:
Est. Graduation Date:
Date you plan to exercise scholarship:
(M)
Age:
Name of College/University/Trade or Vocational School you plan to attend or are enrolled in:
(F)
Sex:
Name City State
Class year starting with this scholarship:
Relative Name Membership No. and Expiration Date
Mother:
Grand Father:
Grand Mother:
Other:
Extra curricular
activities:
Community and/or
Church activities:
Occupational or
Professional goals:
I understand that the decision of the Scholarship Committee is final and that the information contained in this application and accompanying documentation is true and correct to the best of my knowledge.
This form can be completed online and then printed, signed and dated, and delivered with the
completed package
to a member of Chapter 776's Scholarship Committee.
Mail to:
VVA Chapter 776
Attn: Scholarship Committee
P.O.Box 91
Bettendorf, IA 52722
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