Scholarship Fund Application

1. Organizational Information:

Your Full Name *

Your Title

Organization Name *

Address

City

State Zip
Work Phone *

Fax Number

E-mail *

2. Personal Information

Home Address

City

State Zip
Home Phone

Secondary E-mail

For the following questions, it would be advisable to type the questions in a word processing program first, so that you have a copy of your submission, in case anything goes wrong with the form.

3. How did you hear about BAWT? *

600 character count

4. How did you hear about the Amy Chamberlain Scholarship Fund? *

600 character count

5. The recipient of this scholarship will be someone who embodies Amy's sense of leadership, love for the outdoors and has a passion for education and volunteerism. Describe yourself and how you embody Amy’s spirit.*

2000 character count

6. Describe what this scholarship means to you. *

1500 character count

7. Describe your organization and youth served. *

1500 character count

8. If you do not receive this scholarship, does this impact your ability to participate? If so, please explain. *

1000 character count

9. Describe the trips you envision taking: where will you go? # of total youth served, # of trips, and how do you plan to fund these trips? *

1500 character count

10. Describe one of your favorite outdoor adventures and why nature is important to you. *

2000 character count

11. Please provide a minimum of 3 references, including their full name, title, organization, relation to you, phone, and email. *

600 character count