Fairbanks Curling Club Foundation Scholarship Application

Name: __________________________________________________________________

Address: ________________________________________________________________

City: ________________________________State __________________ Zip: ________

Home phone: _______________________ Work or contact phone: _________________

Email address: _________________________________ Date of Birth: ______________

Name of high school: ____________________________Graduation date: ____________

Answer the following as completely as possible. You may attach other papers if space necessitates.

List past participation and involvement in the sport of curling:

List membership in school related organizations (Honor Society, Student Council, etc.):

List positions of leadership held in high school:

List any activity that demonstrates your community involvement:

List any awards received for school or community involvement:

List any job experience you have had:

Describe your financial need:

Please attach required items to the application. These must be turned in to your school counselor no later than April 30. You may also mail them directly to the Fairbanks Curling Club, 1962 2nd Avenue, Fairbanks, AK 99701.

Applicant Signature:

By signing this form, I hereby grant the Fairbanks Curling Club Foundation the unconditional right to use my name, photograph, and essay in connection with press releases and or publications. I also certify that I have read and meet the eligibility requirements for the FCCF scholarship.

________________________________________________ _____________________

Signature of applicant Date