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     Scholarship Application 


NAME:__________________________________________________________________________

ADDRESS:_______________________________________________________________________

CITY:_______________________________________  STATE:__________  ZIP:_______________

DAYTIME PHONE:________________________  EVENING PHONE:_______________________

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.


Mail application and required documentation to:

Amateur Radio Council of Arizona
Scholarship Program
16845 N. 29th Ave., #312
Phoenix, AZ   85053-3041