Pen in Hand Mini-Conference - Youth Scholarship
Application Form
 

Mail to:           

            Midwest Writing Center

225 E. 2^nd St.  Suite 303

Davenport, IA 52801

Phone:  563-324-1410

Scholarship requests:

-Submitted no later than February 20, 2010 for the March 6^th Pen-in-Hand

-Completed by child’s parent and returned with the Workshop Registration form

-You will be notified of any award before February 24, 2010

Father’s Name_________________________________ Mother’s Name______________________________

Home Address ______________________________ City __________________ State ________ Zip______

Home Phone _____________________________________  Business Phone _________________________

Name of Child _____________________________________    Age _______

Information below must be completed in full to be considered.

Total Gross Yearly Household Income Level $ _______________ Total number of children at home _______

Please give a detailed outline of your “financial reasons” of why you need the scholarship.

(Information is kept strictly confidential)                                                              

(Continue on reverse side for additional space)

For Office Use Only

Scholarship: Denied___________ Granted __________