MAX Scholarship Request Form

Name

First Name Last Name

E-mail Address

Phone Number

Area Code Phone Number

Cell Phone

Area Code Phone Number

Mailing Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Previous MAX class(es) you have attended:

Class Tittle and Instructor's name
Class Tittle and Instructor's name
City
Postal / Zip Code	Country

Class Tittle and Instructor's name
Class Tittle and Instructor's name
City
Postal / Zip Code	Country

Have you received scholarship monies before?

Yes No

If yes, for which class(es) did you receive funding?

Class Tittle
Class Tittle
City
Postal / Zip Code	Country

Amount of funding you have received:

Dollars

Names of class(es) you want to attend:

Class Tittle
Class Tittle
City
Postal / Zip Code	Country

How much financial aid do you require?

Dollars

Please write a short explanation of why you need financial assistance at this time.

What would you be willing to do for MAX as a result of getting this scholarship award?

NOTE: Awarding of Scholarships are decided on a case-by-case basis by the MAX Scholarship Committee. Scholarship funds are limited. Further documentation for need may be required. Applicants will be contacted by a committee member regarding scholarship awards or the need for more documentation.

MAX Scholarship Application