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Cascade Warbirds Scholarship ProgramApplication

I wish to apply for the following scholarship:

Private Pilot Ground School and Introduction Flights

Name:

Parent or Legal Guardian:(If applicant is under 18 yrs old)

Address:

City:

State/Province:

Zip/Postal Code:

Cascade Warbirds Scholarship Program Application Form Page 1 of 4

Directions for Submission

Applicant Information

1. Please fi ll out form completely. If additional room is required, continue answers on additional pages as required.

2. Write in Not Applicable (N/A) for unanswered questions rather than leaving a section blank.

3. Mail completed application to CWB, 1066 Yates Road, Oak Harbor, WA 98277

Deadline: Only those applications received by the February, 28 2015 closing date will be eligible for the scholarship.

Questions: Please contact Fred Smyth via Email (fred@fcsmyth.com) if you have any questions about the program or scholarship.

Applicant must be a U.S. Citizen

Home Phone:

Cell Phone:

Email Address:

1/2015

Date of Birth: Gender:

Educational Data From To DiplomaName and address of high school(s) attended: Mo/Yr Mo/Yr Mo/Yr

1.

2.

3.

Cascade Warbirds Scholarship Program Application FormPage 2 of 4

Extracurricular Activities (High School or College): Please list all activities, yrs of membership/involvement, offi ces held, etc.

From To DiplomaName and address of college(s) attended: Mo/Yr Mo/Yr Mo/Yr

1.

2.

3.

Cascade Warbird Scholarship Program Application - Pt II

Cascade Warbirds Scholarship Program Application FormPage 3 of 4

Work Experience List present and past employment and volunteer work experience beginning with your most recent job.

1. Name and Address of Employer From: Mo/Yr To: Mo/yr

References List two references (not family members) familiar with your interest and involvement in aviation. Contact references to obtain their permission for use of their names, occupation, address and phone numbers.

Name Occupation Address Phone Number1.

2.

List jobs you held, duties you performed, skills used or learned, advancements or promotions while employed

2. Name and Address of Employer From: Mo/Yr To: Mo/yr

List jobs you held, duties you performed, skills used or learned, advancements or promotions while employed

3. Name and Address of Employer From: Mo/Yr To: Mo/yr

List jobs you held, duties you performed, skills used or learned, advancements or promotions while employed

Cascade Warbird Scholarship Program Application - Pt III

Cascade Warbirds Scholarship Program Application FormPage 4 of 4

Personal StatementAttach a personal statement of 500 words or less addressing your career aspirations, educational plans, why you want to receive this scholarship and what you have learned from your work/volunteer experiences.

DeclarationI declare that the information I have given in this application is correct and complete. If awarded the Cascade Warbirds scholarship I agree to conduct myself in a professional and ethical manner at all times.Applicant Signature: (If submitting electronically, type your name in the box below for the electronic signature)

Date:

Cascade Warbird Scholarship Program Application - Pt IV

Parent or Legal Guardian Signature (If applicant is under 18 yrs old): (If submitting electronically, type your name in the box below for the electronic signature)

Date: