MAX Scholarship Request Form

MAX Scholarship Application
Name

First NameLast Name
E-mail Address
Phone Number

Area CodePhone Number
Cell Phone

Area CodePhone Number
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Previous MAX class(es) you have attended:

Class Tittle and Instructor's name

Class Tittle and Instructor's name

City

Postal / Zip Code
Class Tittle and Instructor's name

Class Tittle and Instructor's name

City

Postal / Zip Code
Have you received scholarship monies before?

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

Class Tittle

Class Tittle

City

Postal / Zip Code
Amount of funding you have received:
Dollars
Names of class(es) you want to attend:

Class Tittle

Class Tittle

City

Postal / Zip Code
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.
Should be Empty:

MAX Scholarship Application