NAME:__________________________________________________________________________
ADDRESS:_______________________________________________________________________
CITY:_______________________________________ STATE:__________ ZIP:_______________
DAYTIME PHONE:________________________ EVENING
PHONE:_______________________
EMAIL ADDRESS: _______________________________________________________________
CALL SIGN:______________LICENSE CLASS:_____________YR. FIRST
LICENSED:_________
AMATEUR RADIO CLUB
AFFILIATION:______________________________________________
NAME OF INSTITUTION ATTENDING (OR PLANNING TO
ATTEND):____________________
________________________________________________________________________________
COURSEWORK:__________________________________________________________________
MAJOR:_________________________________ MINOR:________________________________
DEGREE BEING SOUGHT:__________________________________________________________
YEAR OF ANTICIPATED
GRADUATION:_____________________________________________
Write a short essay regarding your participation in and
contributions to Amateur Radio. Be sure to
include
your plans for the future, personally, professionally, and as relates to
Amateur Radio.
SIGNATURE OF
APPLICANT:_________________________________DATE:________________
Attach the following to this application:
1. A copy of your current Amateur Radio license.
2. A letter of recommendation from your ARCA affiliated club.
3. Proof of enrollment or acceptance into the institution listed above.
4. A short essay regarding your participation in and contributions to Amateur
Radio. Be sure to include
your plans for the future, personally, professionally, and as
related to Amateur Radio.
E-Mail application and
required documentation to:
ARCA@ARCA-AZ.ORG
NOTE: Applications MUST be E-Mailed. Follow-up hard copies are no longer required. Be sure to
keep a copy for your records
