High Adventure Scholarship Application Form (Page 2 of 2) in pdf

1LT TOM MARTIN MEMORIAL FOUNDATION

HIGH ADVENTURE SCHOLARSHIP APPLICATION

(Please Print)

First Name: _____________________________ Last Name:___________________________________

Mailing Address: _____________________________________________________________________

City / State / Zip: _____________________________________________________________________

Home Phone: _____________________ Cell Phone: _______________ Receive Texts? Y [ ]

N [ ]

E-Mail:_________________________________________ @ ___________________________________

BSA Membership Number: __________________ Scout Rank: ________________ Age: _____________

Home Unit and Number (ie: Troop 2):______________________________________________________

What high adventure activity do you wish to attend: _________________________________________

Date of Activity: _________ Have you applied to attend? _________ Total Cost of Activity:_________

Explain how Scouting has helped you be more adventurous. Include new skills you’ve learned through Scouting, and

explain what you hope to learn or experience through attending this event (Attach an additional sheet if necessary):

__________________________________________________________________________________________________

Attach any letters of recommendation from your Scoutmaster, Pastor or Spiritual Leader, Teacher, or others that can

attest to your character and desire to grow through participating in a high adventure experience.

By signing below, I attest that the information included in this application lives up to the principles found in the Scout Oath and Scout Law.

Furthermore, I agree to meet all requirements of this scholarship if I am selected to receive it. I understand that this may include, but is not

limited to furnishing the local council or the 1LT Tom Martin Memorial Foundation additional information about the high adventure experience I

participated in, providing photos of the experience when possible, and writing a letter of thanks to the 1LT Tom Martin Memorial Foundation

upon my immediate return from the activity.

Signature of Applicant: __________________________________________

Signature of Your Parent or Guardian:______________________________

DATE: _____________

Council Review and Approval: ____________________________________

DATE: _____________

High Adventure Scholarship Application Form Page 2