Haley Rae Martin Scholarship Application

Date________________

Name____________________________________________________________________________________

Address__________________________________________________________________________________

Parents Name_____________________________________________________________________________

Phone______________________________Email_________________________________________________

Age________________School___________________________________

Name of the class or workshop you would like to attend__________________________________________

Please explain why you would like to take this class:

________________________________________________________________________________________

We work hard to have scholarship funds available, but do not have as much as we need to help everyone.

Please tell us if you need a full scholarship or if you can pay part of the tuition.

I need a full Scholarship. The tuition amount I am requesting is $_________________

I can pay $_____________ and request a partial scholarship of $__________________

_______________________________________________________

Signature of Applicant or parent ( if applicant is under 18)

Please return to:

Haley Rae Martin Scholarship Fund

266 North Main St

Concord, NH 03301