Scholorship Application

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Buddy Walk

Scholarship Application

First Name (required)Please fill the required field.

Last NamePlease fill the required field.

If the scholarship is for your child please provide:

Last name

Date of BirthPlease fill the required field.

Address

Address line 2

City

State

Postal/Zip Code

PhonePlease fill the required field.

EmailPlease fill the required field.

Please Select One

I am a person with Down Syndrome

I am a parent of a person with Down Syndrome

I am an immediate family member of a person with Down Syndrome

Type of Scholarship you are requesting funds to attend

Recreational Activity

Educational Program

Conference

Hope Haven Evaluation

Name of Agency this Scholorship is for

Agency Address

Address line 2

City

State

Postal/Zip Code

Agency Contact Person

Why do you want this scholorship

Date of EventPlease fill the required field.

Location of Event

Have you applied for a Scholarship before?

yes

No

If yes when?

The scholarship recipients will be required to share information concerning their experience by a choice of one or more of the following four Member Service Options prior to reimbursement. Please choose your option:

Write an article for our newsletter

Join and participate in a F.R.I.E.N.D.S. Committee

Run an Informational Meeting

Volunteer at a F.R.I.E.N.D.S. event

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By submitting this application you agree to the following statement: If I am approved for funding, I agree to turn in receipts for all expenses I hope to receive reimbursement for, a copy of the conference program, and your Member Service Options. REQUIREMENTS: 1. You must be an active member of F.R.I.E.N.D.S. 2. You must have participated in the Buddy Walk or other Fundraising event. 3. You must live within Hillsborough, Pinellas, or Pasco Counties

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Phone: Hillsborough 813-245-2782 • Address: 11612 Miss Chloe Court, Riverview FL 33579 • E-Mail: info@friendssupport.org