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__________________
notes:____________________________________________________________________________________________

 

Signed By: _______________________________________     _____________________________________

 

Return this form to Bob Check, W8GC, 7395 Brecksville Rd., Independence, OH 44131 w8gc@2cars.org