Kawaihoa Foundation Scholarship Program

Application

To the Applicant:  Type or print neatly in black ink.

NAME OF APPLICANT: _________________________________________________________________________________ 

ADDRESS (Use home mailing address, no P.O. Box)
STREET: _____________________________________________________________________________________________
CITY:  __________________________________________________________STATE:  __________ ZIP: ________________
HOME PHONE: (       ) ___________________________________BUSINESS PHONE: (      ) _______________________
EMAIL: ______________________________________________________________________________________________

Please list previous training and/or experience:

SCHOOL NAME: _______________________________________________________________________________________
INSTRUCTOR: ________________________________________________________________________________________
DESCRIPTION OF TRAINING AND/OR EXPERIENCE:
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________

SCHOOL NAME: _______________________________________________________________________________________
INSTRUCTOR: ________________________________________________________________________________________
DESCRIPTION OF TRAINING AND/OR EXPERIENCE:
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________

SCHOOL NAME: _______________________________________________________________________________________
INSTRUCTOR: ________________________________________________________________________________________
DESCRIPTION OF TRAINING AND/OR EXPERIENCE:
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________

(Use reverse side if additional space needed)


I certify to the best of my knowledge that the information I have provided in this application is accurate.  I give the Kawaihoa Foundation Scholarship Program Director permission to contact my previous school(s) to verify the information provided and to request any additional information needed.

Applicant's Signature: ______________________________________Date: _____________________

Any questions should be directed to:
Kawaihoa Foundation Scholarship Program
P.O. Box 670, Kane'ohe, HI  96744
Phone:  808 292-2738
Email:  hula@kawaihoa.org

Revised: 04/29/2009

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