ARRLWeb: ARRL Foundation Scholarship Application

1. Please see the final page for additional instructions. Read thoroughly before completing. Submit no earlier than October 1^st and no later than February 1^st(a 5 month window). Scholarships are for the academic year that will commence on or after May 15^th. The below form consists of five pages plus one page of additional instructions.

Last________________________________________ First_________________ Middle______________

Birth Date (mm/dd/yy)_____________ Age________ E-mail___________________________________

Home Address___________________________________________ Daytime Phone______________________ ______________________________________________________

City_________________________________________________ State_______ ZIP______________________

School Name and Location	Dates		Degree or Diploma	GPA	Enter GPA Basis (4 pt, 5 pt, 12 pt, 100%, etc.)	Class Standing (X of Y)
School Name and Location	From	To	Degree or Diploma	GPA	Enter GPA Basis (4 pt, 5 pt, 12 pt, 100%, etc.)	Class Standing (X of Y)

__________________________________________________________________________________

List all community, extracurricular or volunteer activities during last four years. Include dates and/or period of the activity. Include any leadership positions held and dates.

__________________________________________________________________________________

Call Sign___________________ License Class_______________ Month/Year First Licensed_______ `

List all ham radio or ham radio related organizations with which you are or have been associated during the last four years. Include dates. Include any leadership positions held and dates.__________________________

__________________________________________________________________________________

Describe your current ham radio participations, operating activities, preferences, modes and bands. If not currently participating or operating, explain why.

__________________________________________________________________________________

What role has amateur radio played in your life (attach enclosure if necessary)?__________________

__________________________________________________________________________________

Major Field of Study:__________________________________________________________________

Career Intentions:____________________________________________________________________

Please explain why you have made these choices (attach enclosure if necessary):________________

__________________________________________________________________________________

Name_____________________________________________________________________________

Address____________________________________________________________________________

__________________________________________________________________________________

9. Estimate of Schooling Costs for Next Academic Year: Total $_________________

Tuition $___________ Board & Room $__________ Books & Supplies $_________ Misc $__________

Are you presently or will you be the beneficiary of any other scholarship, grant or stipend? If so,
list name of donor(s) and the amount(s) for next year______________________________________

__________________________________________________________________________________

Family_________ % Yourself_________ % Scholarship or grant__________ % Loan_________ %

Employer__________________________________ Type of Work _____________________________

Started There______________________________ Nr Hours Per Week________________________

12. Answer the following questions for individual(s) who claimed you or will claim you as a dependent on the tax return for the calendar year immediately prior to February 1^st application deadline. If not applicable, enter "none" and see question 13.

Estimated Gross Income:______________________________________________________________

Ages of other household members who are also dependents:_________________________________

13. Answer the following questions ONLY if you were not claimed as a dependent on a tax return for the calendar year immediately prior to February 1^st application deadline. If not applicable, enter 'none" and see question 12.

Gross Income (include spouse's, if employed):_____________________________________________

Ages of dependent children:____________________________________________________________

__________________________________________________________________________________

I hereby attest that I understand the award terms and that the foregoing information provided by me is true to the best of my knowledge. If I am granted a scholarship by The ARRL Foundation, Inc., I will permit my name to be used for publicity releases to further the aims and purposes of The ARRL Foundation, Inc.

Signature_____________________________________________________ Date_________________

Last________________________________________ First_________________ Middle______________

Birth Date (mm/dd/yy)_____________ Age________ E-mail___________________________________

Home Address___________________________________________ Daytime Phone______________________ ______________________________________________________

City_________________________________________________ State_______ ZIP________________

Major Field of Study____________________________________________________________________

College or University to be attended_______________________________________________________

NOTE: If chosen, we'd like to promote your win in your local media. Please provide the name of your local newspaper, television station and radio station. __________________________________________________________________________

I am applying for the scholarships indicated. I am eligible for each scholarship for which I have applied.

	Senator Barry Goldwater, K7UGA			Henry Broughton, K2AE Memorial
	Mary Lou Brown			Donald Riebhoff Memorial
	Earl I. Anderson			New England FEMARA
	Paul and Helen Grauer			Edmond A. Metzger
	Perry F. Hadlock			Dr. James L. Lawson Memorial
	You've Got a Friend in Pennsylvania			Mississippi Scholarship
	L. Phil Wicker			Fred R. McDaniel Memorial
	Charles N. Fisher Memorial			Six Meter Club of Chicago
	The General Fund			Chicago FM Club
	K2TEO Martin J. Green, Sr. Memorial			Eugene "Gene" Sallee W4YFR Memorial
	Irving W. Cook WA0CGS			Albuquerque Amateur Radio Club
	The PHD ARA			Francis Walton Memorial
	Charles Clarke Cordle Memorial			Central AZ DX Assn.
	Tom and Judith Comstock			The Strohmeier Scholarship
	Yankee Clipper Contest Club Scholarship			Albert Hix W8AH Scholarship
	IRARC/Rubino Scholarship			Cebik Memorial Scholarship
	William Bennett W7PHO Memorial Scholarship			Carole J. Streeter Scholarship
	Louisiana Memorial Scholarship			The NCDXF Scholarship
	The Dayton Amateur Radio Association Scholarships			The Challenge Met Scholarship
	The Yasme Foundation Scholarship			Seth Horen, K1LOM, Memorial Scholarship
	The Zachary Taylor Stevens Memorial Scholarship			The Richard W. Bendicksen Memorial Scholarship
	The Gary Wagner, K3OMI Scholarship

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2. The application and transcript MUST be postmarked during the application filing window of October 1^st to February 1^st. There are no exceptions. All applications or transcripts postmarked prior to October 1^st or after February 1^st will be disqualified.

3. Scholarships are awarded for the academic year that will begin no earlier than May 15th following the application deadline.

4. A signed original application and paper copies of all transcripts are required. E-mail submissions will not be accepted.

6. Transcripts must cover your entire high school career to date and, if in college, must include all semesters for which grades have been awarded. If you are applying for graduate school assistance, high school transcripts are not necessary.

7. Letters of reference are not required, but can be attached by applicant (no more than three).

9. If the space provided for your responses is not large enough, you may write "see attached" on the application and include an enclosure or resume. Be sure the enclosure or resume is clearly marked as to the question each portion applies and includes your full name.

10. Use only one side of the application form. Please do not write on the reverse side. Attach additional sheets as necessary.

11. The narrative responses to questions 6 (the role of amateur radio) and 7 (why you made these choices) must not exceed one page each.

14. Please ensure each entry can be fully understood and appreciated by the members of the ARRL Foundation. For example, indicating membership in Tau Beta Pi does not completely explain the nature of the honor. It would be better to indicate that one was elected to membership in the National Honorary Engineering Fraternity, Tau Beta Pi.

15. It should be noted that some scholarships require attendance at specified schools or at schools within specified areas or states. Scholarships may also require enrollment within certain major fields of study. You will not be considered for these scholarships unless your application clearly provides the necessary qualifying information.