NORTHWEST ARKANSAS FENCING FOUNDATION SCHOLARSHIP APPLICATION

Part 1. Applicant Information - (REQUIRED)

Child's Full Name
M F Age

Part 2. Additional Information - (REQUIRED)

The following information is required to complete the application for processing. Completed Application must be submitted, at least, 2 weeks prior to registration deadline to allow time for processing.

If approved for a NWAFF scholarship, you will be required to submit proof of household income for the previous month. Income proof must be submitted within one month after acceptance.

Part 3. List ALL Household Members/Income from Last Month- (REQUIRED)

Receive Food Stamps: YES NO

Free Lunch Program: YES NO

List everyone in household:

Name (First, Last)	Age	Gross Income/ How Often Received	Welfare, Child Support, Alimony	Pensions, Retirement, Social Security	Other	Check If No Income
(Example) Jane Doe	30	$300/bi-mo	$150/wk	$600/mo
		$	$	$	$
		$	$	$	$
		$	$	$	$
		$	$	$	$
		$	$	$	$
		$	$	$	$
		$	$	$	$
		$	$	$	$

Part 4. Signature and Personal Information (Adult must Sign)

I certify (promise) that all information on this application is true and that all income is reported. I understand that Northwest Arkansas Fencing Foundation officials reserve the right to request more information and verify (check) the information. I, also, understand that Northwest Arkansas Fencing Foundation is not responsible for injury or loss of property while participating in above scholarship activity. I do, hereby, release Northwest Arkansas Fencing Foundation, it's employees, sponsors & Board of Directors from any liability for any accident or injury.

Electronic Signature (Full Name)
Relationship to Student
Today's Date
Home Phone
Work Phone
Message Phone
Street or Rural Address
City
State
Zip
Email Address
Emergency Contact
Emergency Contact Relationship
Emergency Phone

Part 5. Demographic Information - (Optional)

Name of School
County of Residence

Part 6. Child's racial and ethnic identities - (Optional)

Caucasian	African-American	Native American	Native Hawaiian
Hispanic or Latino	Multi-Racial	Other Pacific Islander

Part 7. Captcha

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