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Youth Scholarship

Zachary Culnan Memorial Family Fund - Activity Scholarship Fund Application

Zachary Culnan Youth Scholarship Application

First Name *
Last Name *
Country
Address Line 1 *
City *
State/Province *
Postal Code *
Describe what being involved in this sport or activity means to you.
Describe what you need for this sport or activity, and why it is important.
Please include a note of recommendation from a teacher, counselor, family member or caregiver to provide some background information.
No file selected
If there is a barrier that may prevent you from using this scholarship, what would it be?

The Zachary Culnan Memorial Family Fund - Activity Scholarship may not be able to fund the entire amount of assistance required. Requests in excess of $500 may be difficult to fill. All payments will be made directly to the activity, sponsoring business, or organization, or another third party. Donation requests will not be made directly to the individual or family.

By signing below, I give permission for CAPTAIN CHS to use photos of the sponsorship recipient for publicity purposes. Please type "Yes" in the text box below.
Please type your name as signature to this submission.
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